Remote monitoring of analyte measurements

ABSTRACT

Methods and apparatus, including computer program products, are provided for remote monitoring. In some example implementations, there is provided a method. The method may include receiving, at a remote monitor, a notification message representative of an event detected, by a server, from analyte sensor data obtained from a receiver monitoring an analyte state of a host; presenting, at the remote monitor, the notification message to activate the remote monitor, wherein the remote monitor is configured by the server to receive the notification message to augment the receiver monitoring of the analyte state of the host; accessing, by the remote monitor, the server, in response to the presenting of the notification message; and receiving, in response to the accessing, information including at least the analyte sensor data. Related systems, methods, and articles of manufacture are also disclosed.

INCORPORATION BY REFERENCE TO RELATED APPLICATIONS

Any and all priority claims identified in the Application Data Sheet, orany correction thereto, are hereby incorporated by reference under 37CFR 1.57. This application is a continuation of U.S. application Ser.No. 14/144,532, filed Dec. 30, 2013, which is a continuation of U.S.application Ser. No. 13/842,679, filed Mar. 15, 2013, which claims thebenefit of U.S. Provisional Application No. 61/747,717, filed Dec. 31,2012, the disclosures of which are hereby expressly incorporated byreference in their entirety and are hereby expressly made a portion ofthis application.

FIELD

The present disclosure generally relates to remote monitoring.

BACKGROUND

Diabetes mellitus is a disorder in which the pancreas cannot createsufficient insulin, such as in the case of Type I diabetes and/or inwhich insulin is not effective, such as Type 2 diabetes. In a diabeticstate, a victim suffers from high blood sugar, which causes an array ofphysiological derangements, such as kidney failure, skin ulcers, orbleeding into the vitreous of the eye, associated with the deteriorationof small blood vessels. A hypoglycemic reaction, such as low bloodsugar, may be induced by an inadvertent overdose of insulin, or after anormal dose of insulin or glucose-lowering agent accompanied byextraordinary exercise or insufficient food intake.

A diabetic person may carry a self-monitoring blood glucose (SMBG)monitor, which typically requires uncomfortable finger pricking methods.Due to the lack of comfort and convenience, a diabetic typicallymeasures his or her glucose level only two to four times per day.Unfortunately, these time intervals are spread so far apart that thediabetic will likely find out too late, sometimes incurring dangerousside effects, of a hyperglycemic or hypoglycemic condition. In fact, itis not only unlikely that a diabetic will take a timely SMBG value, butadditionally the diabetic will not know if his blood glucose value ishigher or lower based on conventional methods.

Consequently, a variety of non-invasive, transdermal (e.g.,transcutaneous) and/or implantable electrochemical sensors are beingdeveloped for continuously detecting and/or quantifying blood glucosevalues. These as well as other types of devices generally transmit rawor minimally processed data for subsequent analysis at a remote device,which can include a display, to allow presentation of information to auser hosting the sensor.

SUMMARY

Methods and apparatus, including computer program products, are providedfor remote monitoring of analyte data. In some example implementations,there is provided a method. The method may include receiving, at aremote monitor, a notification message representative of an eventdetected, by a server, from analyte sensor data obtained from a receivermonitoring an analyte state of a host; presenting, at the remotemonitor, the notification message to activate the remote monitor,wherein the remote monitor is configured by the server to receive thenotification message to augment the receiver monitoring of the analytestate of the host; accessing, by the remote monitor, the server, inresponse to the presenting of the notification message; and receiving,in response to the accessing, information including at least the analytesensor data.

In some example implementations, the above-noted aspects may furtherinclude additional features described herein including one or more ofthe following. The notification message may be received from at least afirst wireless connection between the remote monitor and a notificationservice coupled to the server, wherein the additional information may bereceived from at least a second wireless connection between the remotemonitor and the server. The first wireless connection may comprise apersistent, encrypted connection configured to carry a short messagepushed by the notification service to a notification message center atthe remote monitor, and wherein the second wireless connection maycomprise a momentary, encrypted connection established, in response theaccessing, to provide the additional information comprising at leastadditional analyte sensor data. The presenting may further compriseinhibiting access to one or more applications at the remote monitoruntil an action at the remote monitor is detected to indicate receipt ofthe notification message, wherein the remote monitor further maycomprise a monitoring application. The notification message may bepresented as a momentary message on a display at the remote monitor,without the inhibiting access. The at least one of the remote monitorand the receiver may comprise one or more of a mobile station, awireless terminal, a tablet, a smart phone, a multi-mode wirelessdevice, and a computer. The server may comprise at least one processorconfigured to receive analyte sensor data from the receiver, process theanalyte sensor data to detect the event, and forward, when the event isdetected, the notification message to the remote monitor based on one ormore rules mapping the event to the remote monitor designated to receivethe notification message for the detected event. The event may bedetected based on a first set of rules at the server, wherein the firstset of rules used to generate the notification message may be differentfrom a second set of rules used to detect alerts sent to the receivercoupled to a sensor system at the host. The receiver may include, orcouple to, a gateway interfacing a wireless connection to a public landmobile network and the server. A plurality of remote monitors may beconfigured, wherein at least one of the plurality of remote monitors maybe designated as a primary monitor, and at least one of the plurality ofremote monitors may be designated as a secondary monitor. The remotemonitor may configure at least one rule representative of a triggercausing an alert to be sent by the server to the receiver. The remotemonitor may configure one or more invitations sent to one or moredevices to invite the one or more devices to monitor the receiver. Theserver may send a message acknowledging a receipt of the notificationmessage. The notification message may include at least one of anindication of a need to calibrate a sensor and an acknowledgementmessage indicating at least one of an action or an acknowledgement sentby the receiver in response to an alarm sent to the receiver. Theactivation of the remote monitor may comprise opening the monitoringapplication. A connection may be established between the remote monitorand the server to enable the receiving of the information including theanalyte sensor data. The server may register at least one of the remotemonitor, the receiver, an analyte sensor coupled to the receiver, andthe registration may include a code provided by a health care provider.The method may be implemented on an apparatus comprising at least oneprocessor and at least one memory including code, which when executed bythe at least one processor causes the apparatus to provide the method. Acomputer-readable storage medium may include code which when executed byat least one processor causes the method.

In another aspect, there is provided a method. The method may includereceiving, at a remote monitor, an invitation to access a secure serverand data associated with a receiver monitoring an analyte state of ahost; and modifying, by the remote monitor, a rule defining an alertrepresentative of an event associated with the analyte state of thehost, wherein the alert, when triggered, causes a message to be sent tothe remote monitor to notify the remote monitor of the event.

In some example implementations, the above-noted aspects may furtherinclude additional features described herein including one or more ofthe following. The modifying the rule may comprise varying a firstthreshold associated with a low level of glucose at the host, varying asecond threshold associated with a high level of glucose at the host,varying a delay between when an associated alert is triggered by areceiver and a notification message is sent to the remote monitor,and/or varying a time value when a reminder notification is sent to theremote monitor. The method may be implemented on an apparatus comprisingat least one processor and at least one memory including code, whichwhen executed by the at least one processor causes the apparatus toprovide the method. A computer-readable storage medium may include codewhich when executed by at least one processor causes the method.

It is to be understood that both the foregoing general description andthe following detailed description are example and explanatory only andare not restrictive. Further features and/or variations may be providedin addition to those set forth herein. For example, the implementationsdescribed herein may be directed to various combinations andsubcombinations of the disclosed features and/or combinations andsubcombinations of several further features disclosed below in thedetailed description.

DESCRIPTION OF THE DRAWINGS

In the drawings,

FIG. 1 depicts a high-level system architecture of a remote monitoringsystem in accordance with some exemplary implementations;

FIGS. 2A-2C illustrate different system architectures of the remotemonitoring system of FIG. 1 in accordance with some exemplaryimplementations;

FIG. 3 depicts an example process for notifying a remote monitor of anevent in accordance with some example implementations.

FIGS. 4A and 4B depict examples of notification messages 170 and 172,respectively, in accordance with some implementations.

FIG. 5 depicts an example of a sensor electronics module in accordancewith some example implementations.

FIG. 6 is a block diagram of an implementation of a gateway inaccordance with some implementations.

FIGS. 7A and 7B depict an example of a docking station in accordancewith some implementations.

FIG. 8 depicts an implementation of a gateway or docking stations inaccordance with some implementations.

FIG. 9 illustrates an exemplary display page to facilitate entry of theserial number of a receiver for other unique identifier in accordancewith some implementations.

FIG. 10 is a flow chart depicting a process for setting up hostmonitoring system in accordance with some implementations.

FIGS. 11A and 11B are exemplary views of a status page in accordancewith some implementations.

FIG. 12 depicts an example invitation page presented at a remote monitorin the form of an email message in accordance with some implementations.

FIG. 13 depicts an example page that may be presented on a display ofthe host computing device.

FIG. 14 illustrates an overview page in accordance with someimplementations.

FIG. 15 is an exemplary settings display page in accordance with someimplementations.

FIG. 16 is a flowchart of an exemplary process of remote monitoringusing a remote monitor.

FIG. 17 is an implantation of a settings page that can allow the remotemonitor to configure remote monitoring settings of a host in someimplementations.

FIGS. 18A and 18B are two different implementations of a dashboard pagein accordance with some implementations.

FIG. 19 is an exemplary page that provides a trend graph of a host'smonitored analyte concentration in accordance with some implementations.

DETAILED DESCRIPTION

Implementations described herein can include a system for one or morecaretakers (e.g., a parent, spouse or healthcare practitioner) toremotely monitor health characteristics of one or more hosts. The healthcharacteristics can include an analyte concentration of a host, such asglucose, or a bodily function, such as heart rate, blood pressure,temperature and the like. In addition, other characteristics of a hostcan be monitored to facilitate care of a host, such as a location of thehost, state of a host (e.g., exercising, sleeping, or working) and thelike. The health characteristics and other characteristics can begathered using a host monitoring system that incorporates a computingdevice, such as a smart phone, and one or more sensors, such acontinuous glucose sensor, heart-rate monitor, GPS device, etc.Additionally, a host can manually input information into the computingdevice, such as meal information, medication administration times andamounts, and the like. The information gathered by the host monitoringsystem can then be transmitted to one or more remote monitors used bycaretakers. The caretaker(s) can then receive information about thehost's health condition using a remote monitoring system. In someimplementations, a host monitoring system can transmit informationdirectly to the one or more remote monitors and/or the host monitoringsystem transmits information first to a remote server, which thentransmits information to the host monitor.

For purposes of illustration only, the following example is anon-limiting exemplary environment in which implementations of remotemonitoring systems described herein can be used.

In this exemplary environment, a host having diabetes is monitored byseveral different caretakers. The host has a continuous glucosemonitoring system, such as the DexCom G4® Platinum continuous glucosemonitoring system, commercially available from DexCom, Inc., whichprovides measurements of the host's glucose levels on a display device,such as the DexCom G4® Platinum Receiver, also commercially availablefrom DexCom, Inc.

Further, in this exemplary environment, the display device can be incommunication with a gateway device, either wired communication orwireless communication. The gateway device gathers information,including real-time or near-real-time glucose concentration values, fromthe display device and transmits the information to a secure server. Thegateway device can include a smartphone, such as an iPhone 4S or iPhone5, each commercially available from Apple, Inc., and a host monitoringsoftware application that comprises instructions configured to cause thesmartphone to function as the gateway. The host monitoring softwareapplication can be in the form of a so-called “App” downloaded from theApple App Store operated by Apple, Inc. The gateway can transmitinformation gathered from the continuous glucose monitoring systemwirelessly to the secure server over a cellular network, Wi-Fi network,and the like.

The remote server can store and monitoring the information received fromthe remote monitoring system. The monitoring can include comparingglucose values of the host (generated by the continuous glucosemonitoring system and transmitted to the server via the gateway) topredetermined thresholds and initiating an action if a threshold isexceeded. For example, the server can compare a current glucose valuewith a predetermined glucose threshold and initiate a notification, suchas a text message over a cellular network, to a remote monitoring systemif the glucose value exceeds the threshold. The server can also providehistorical and current glucose values to the remote monitoring system ondemand.

As discussed above, the remote monitor can be used by a caretaker tomonitor health characteristics of a host, which in this exemplaryenvironment is glucose concentration levels of the host. Similar to thehost monitoring system, the remote monitoring system can be asmartphone, such as an iPhone 4S or iPhone 5, and a remote monitoringsoftware application that comprises instructions configured to cause thesmartphone to function as the remote monitoring system. The remotemonitoring software application can be in the form of a so-called “App”downloaded from the Apple App Store operated by Apple, Inc. The remotemonitoring system can receive notifications from the server when athreshold is exceeded, notifying the caretaker using the remotemonitoring system of the condition of the host. The remote monitoringsystem can also be used to view historical information about themonitored glucose levels of the host and modify notification rules, suchas the threshold levels that trigger notifications.

The following provides more detail of specific implementations, whichmay or may not include features noted in the above-discussed exemplaryenvironment.

FIG. 1 depicts a high-level system architecture of an implementation ofremote monitoring system 100. Here, remote monitoring system 100includes a plurality of host monitoring systems 198A-198N connected to aplurality of remote monitors 114A-114M via network 118. Each host 198monitoring system may be one or more health monitoring devices thatgather health-related data associated with a host and transmit thehealth-related data via network 108. Exemplary implementations of healthmonitoring systems 198A-198N are described in more detail elsewhere inthis disclosure, but in some implementations can include one or moresensors and computing devices operably coupled to the sensors to gather,process and transmit the health-related data. Network 108 can includeany communication medium, such as wired and wireless networks includingcellular networks, local area networks, wide area networks, Wi-Finetworks, the internet, and the like. Network 108 can also include oneor more servers 110 to process the health-related data received from andtransmit notifications and data to one or more remote monitors 114A-114Meither automatically or in response to a request from the remotemonitors. Each remote monitor 114A-114M can be associated with anindividual or entity that is monitoring the health of one or more ofhosts using host monitoring systems 198A-198N. Each remote monitor 114can be associated with a caretaker, such as parent, spouse, doctor,nurse, hospital and the like. The remote monitor 114 can include acomputing device that receives notifications from network 108 andrequests additional information, such as historical health-related datagenerated by one or more host monitoring systems 198A-198N.

Remote monitoring system 100 of FIG. 1 can also include workstation 22.Workstation 22 may be a computing device, such as a personal computer,that has access to remote monitoring system 100 for configuring settingsof system 100 and/or viewing information associated with one or morehost monitoring systems 198, such as reports generated by remotemonitoring system based on a host's health-related data.

Using remote monitoring system 100 of FIG. 1, one or more remotemonitors 114A-11M can monitor one or more host monitoring systems198A-198N. That is, host monitoring system 198A can be monitored byremote monitors 114A and 114B, and at the same time, remote monitor 114Acan monitor host monitoring system 198B in addition to host monitoringsystem 198A. Various permissions and invitations can be used to limitwhich remote monitors 114A-114M can monitor host monitoring systems198A-118N, as described in more detail later in this disclosure.

In one non-limiting example of remote monitoring system 100, each hostmonitoring system 198A-198N comprises a smartphone, such as an iPhonefrom Apple, Inc., and, likewise, each remote monitor 114A-114M has asmart mobile telephone, such as an iPhone. Each host mobile telephonehas a host software application downloaded from a server of network 108,the application configuring the mobile telephone to perform any of thefunctions by host monitoring system 198 described herein, includinggathering and transmitting health-related data used in remote monitoringsystem 100. The host software application can be an applicationdownloaded using the App Store service hosted by Apple, Inc. Similarly,each remote monitor 114A-114M has a remote monitoring applicationdownloaded from a server of network 108, the remote monitoringapplication configuring to perform any of the remote monitoringfunctions described herein, including receiving notifications andrequesting health-related data of a host. The remote monitoringapplication can also be a software application downloaded using the AppStore service hosted by Apple, Inc.

FIG. 2A depicts an example of system 100 for monitoring health-relatedinformation of host 199, in accordance with some exampleimplementations. Here, the remote system 100 includes a continuousanalyte monitoring system 8 including a sensor electronics module 12 anda continuous analyte sensor 10. The system 100 may also include devicesand/or sensors, such as medicament delivery pump 2 (e.g., an insulin orglucagon pump), a glucose meter 4 (e.g., a blood finger stick meter),and any other device and/or sensor. The continuous analyte sensor 10 maybe physically connected to sensor electronics module 12 and may beintegral with (e.g., non-releasably attached to) or releasablyattachable to the continuous analyte sensor 10.

The sensor electronics module 12, medicament delivery pump 2, a glucosemeter 4, and/or other devices/sensors may couple via a wired or wirelesslinks to one or more devices, such as a receiver 102. The receiver 102may include a display 122 to enable the host 199 to present informationfrom continuous analyte sensor 10, delivery pump 2, glucose meter 4,and/or other devices/sensors.

The implementation of system 100 illustrated in FIG. 2A provides via agateway 104, networks 108A-C, a secure server 110, and a notificationservice 112, notification messages to one or more remote monitors114A-114M, such as remote monitor 114A. Each remote monitor 114 may beconfigured at system 100 to provide a separate mechanism for monitoringthe activity associated with host 199 including receiver 102, continuousanalyte sensor 10, delivery pump 2, glucose meter 4, and/or any othersensor associated with host 199.

To illustrate by way of an example, host 199 may access receiver 102 toview data from, or control aspects of, continuous analyte sensor 10,delivery pump 2, and/or glucose meter 4. However, another entity, suchas a parent, a care giver, a health care professional, a school nurse,and the like, may have remote monitor 114 receive notification messagesrepresentative of certain events determined based on sensor data fromreceiver 102, continuous analyte sensor 10, delivery pump 2, and/orglucose meter 4, and view historical and substantially real-time sensordata. For example, an event may comprise one or more of the following: ameasured analyte sensor value above or below a predetermined threshold,a rate of change or a level of glucose measurements above apredetermined threshold, a predicted glucose value approaching (orpredicted to approach) a predetermined threshold, a host 199 notresponding to a prompt, a message, or an alert displayed at receiver102, and/or any other event detected by secure server 110 and/orreceiver 102. In the example of FIG. 2A, the remote monitor 114 depictsa notification message 132 indicating low glucose level of host 199. Assuch, an entity having remote monitor 114 may assist host 199 byproviding an additional layer of monitoring and oversight of host 199,as well as receiver 102, continuous analyte sensor 10, delivery pump 2,glucose meter 4, and the like.

In some example implementations, the remote monitor 114 may include aprocessor, a computer-readable storage medium (e.g., memory, storage,and the like), a radio access mechanism (e.g., a modem and the like),and/or a user interface. The computer readable medium may include codewhich when executed by a processor provides one or more applications,operating systems, and the like. For example, an application may beconfigured as a remote monitoring application configured to monitorand/or control one or more of the receivers 102, the continuous analytesensor 10, the delivery pump 2, the glucose meter 4, and the like. Insome implementations, the remote monitor 114 is an iPhone mobile phonefrom Apple, Inc. and the application is an application downloaded overthe Internet using the App Store service operated by Apple, Inc.

In some example implementations, the remote monitor 114 may comprise oneor more of the following: a mobile station, a wireless terminal, atablet, a smart phone, or the like. For example, the remote monitor 114may be implemented as a wireless handheld device, a wireless plug-inaccessory, or the like. Moreover, the remote monitor 114 may beimplemented as multi-mode device configured to operate using a pluralityof radio access technologies, such as Long Term Evolution (LTE),wireless local area network (WLAN) technology, such as 802.11 Wi-Fi andthe like, Bluetooth, Bluetooth low energy (BT-LE), near fieldcommunications (NFC), and any other radio access technologies. Moreover,the remote monitor 114 may be configured to establish connections toaccess points in network 108A, such as cellular base stations, Wi-Fiaccess points, and the like, using at least one of the plurality of theradio access technologies. Although some of the examples herein refer tothe remote monitor as a mobile, wireless device, the remote monitor mayalso be implemented as a stationary device, such as a personal computerand the like.

In some example implementations, the receiver 102 may be configureddifferently than the remote monitor 114. For example, the receiver 102may include a different set of rules defining when an alert is sent tothe receiver 102, when compared to the set of rules used to trigger anotification to the remote monitor 114. Moreover, although the receiver102 may trigger alerts on its own (e.g. applying thresholds to sensordata received from sensor system 8), receive alerts from sensor system 8or receive alerts directly from the secure server 110, the remotemonitor 114 may be configured to receive messages, such as shortmessages, text messages, and the like, from a notification service 112,and these messages can serve to activate the remote monitor 114, such asactivating the remote monitor application of the remote monitor. Forexample, the remote monitor 114 may close the remote monitor applicationsession (as well as close network connection 109 to secure server 110),when the remote monitor application is not actively being used toconserve power at the remote monitor. When this is the case, thenotification service 112 may send a message over network connection 111to allow activation of the remote monitor 114 and/or a remote monitorapplication (and this activation may be automatic or under the controlof a user of remote monitor 114).

Although some of the examples described herein refer to secure server110 as an intermediary node between the receiver 102 and the remotemonitor 114, in some example implementations, the secure server 110 maybe by-passed. For example, the gateway 104 may communicate directly withthe remote monitor 114, and vice-versa. In addition, the gateway 104 andreceiver 102 may receive notification messages to activate anapplication at the receiver 102 or gateway 104 to allow the host to bealerted.

FIG. 3 depicts an example process 197 for notifying a remote monitor 114of an event associated with receiver 102, continuous analyte sensor 10,delivery pump 2, glucose meter 4, and/or host 199, in accordance withsome example implementations. The description of FIG. 3 also refers toFIG. 2A.

In some example implementations, the secure server 110 may registerand/or configure one or more of the receiver 102, the continuous analytesensor 10, the delivery pump 2, the glucose meter 4, and the host 199before process 197 is initiated, although registration and/orconfiguration may occur at other times as well. The registration processmay be performed to register the receiver 102, the continuous analytesensor 10, the delivery pump 2, the glucose meter 4, the remote monitor114, and/or the host 199 with the secure server 110. Moreover, theconfiguration process may be performed to configure system 100 includingthe identities of the one or more remote monitors used to monitorreceiver 102, configure one or more rules used to trigger notificationmessages to the remote monitors, configure one or more rules designatingprimary and secondary remote monitors, configure one or more rulesestablishing schedules for the primary and secondary monitors, configureone or more rules defining an escalation sequence representative of whento elevate an event to a primary monitor or a secondary monitor, and thelike.

At 180, receiver 102 may send sensor data, such as analyte data fromsensor system 8 and the like, to gateway 104, which then forwards thesensor data at 182 to secure server 110. For example, receiver 102 maycouple to gateway 104 via a wired or wireless connection, and gateway104 may couple to secure server 110 via network 108A. The gateway 104may be configured to pull current and/or historical data from thereceiver 102 on its own or in response to a request from secure server110.

At 186, the secure server 110 may determine whether one or more of theremote monitors 114A-114M, such as remote monitor 114A, should be sent anotification message regarding an event. The secure server 110 maydetermine whether to send a notification message to a remote monitorbased on received sensor data (as well as any other data available atthe secure server), which triggers an event (or satisfies a rule) at thesecure server. For example, secure server 110 may receive the sensordata at 182 and then process the received sensor data alone or alongwith other data (e.g., historical data, data from other sources ofpatient information, and the like) to determine whether to send thenotification message alerting the remote monitor 114 of the event. Thesecure server 110 may also receive information from other systems, suchas a heath management system or a health care provider's systems, andthis information may be used to trigger notification messages to theremote monitor. In addition, the secure server 110 may send notificationmessages to confirm whether the remote monitor is still activelymonitoring the host 199.

To illustrate by way of an example, receiver 102 may receive sensor datafrom host 199 and transmit the sensor data to secure server 110 viagateway 104 and network 108A, and the secure server 110 may process thesensor data and determine a low level of glucose by comparing the mostcurrent glucose level data to a predetermined low glucose threshold,although other events described herein may be detected as well. Thesecure server 110 may include one or more rules defining events, such asthe low level of glucose exceeding a threshold and include rulesdefining the identities of the remote monitors receiving a notificationmessage indicating the low level of glucose at the host 199. Forexample, the rule may define that when a low level of glucose isdetected for a certain host, a certain remote monitor should receive anotification message. The notification message may include an indicationof the low level of glucose (e.g., the glucose value), the time of theevent, and other information, such a plot of current and past glucoselevels, host information (e.g., name), and/or any other host relatedinformation.

The one or more rules defining the events may be defined during theconfiguration process by a user, such as host 199, a caregiver, and/orpredefined as default rules (which may be reconfigured by a user or maybe adapted by the system 100 over time to accommodate the host). In someexample implementations, the one or more rules may define a thresholdvalue representative of a severity of the event that should be reportedto the one or more remote monitors, the times of day when a notificationmessage should be sent to each of the remote monitors, the identities(e.g., phone number, Internet Protocol address, email address, and thelike) of the one or more remote monitors, and the like.

Furthermore, the one or more rules may include escalation rules, so thatevents can be handled differently based on severity of event, type ofevent, and/or lack of responsiveness by a designated remote monitor. Forexample, a rule may define that a glucose value below a certain valueshould not be the subject of a notification message to remote monitor114 (although an alert message may be sent to the receiver 102 orgateway 104 to notify the host 199); another rule may define that aglucose value between a range of values should be the subject of anotification message to remote monitor 114; while another rule maydefine sending, when a dangerously low glucose value is detected,notification messages to remote monitor 114A as well as other remotemonitors 114B-M. In some example implementations, the rules used totrigger alerts to host 199 at receiver 102 may be different from therules used to send notification messages to remote monitor 114, althoughone or more of the rules may be the same as well.

Although the previous examples described an event associated with lowglucose levels, other types of events may be defined as well at thesecure server 110 in order to trigger notification messages to theremote monitor 114 and/or trigger alerts to the receiver 102.

At 187, the secure server 110 may send an alert to the receiver 102and/or gateway 104. The alerts may be triggered based on events whichare the same or different as the rules used to trigger events fornotification messages to the remote monitor 114. Moreover, the secureserver 110 may include a delay between when the alert is sent at 187 andthe notification messages are sent at 188-190. For example, the delaymay allow the receiver 102 to acknowledge or take action before sendingmessages at 188-190, as the receiver may also have a set of rules thatare the same or different than those for the receiver stored on thesecure server. That is, the receiver 102 may trigger an alert based onrules residing within the receiver, and the receiver may receive analarm from the secure server based on a different set of rules stored atsecure server. The delay prior to the secure server 110 sending anotification to the receiver 102 may be varied by the secure serverbased on the severity or type of event, and the delay may be configuredby a user and/or configured programmatically. For example, a first delaymay be used for a first low analyte threshold, but no delay may be usedfor a second, more severe, low glucose threshold.

At 188-190, a notification message may be sent to one or more remotemonitors based on whether one or more rules are triggered at 186. Insome example implementations, the secure server may send a notificationmessage to a push notification service 112, which then pushes anotification to the remote monitor(s). Examples of push notificationservices include the Apple Push Notification Service (APNS) and GoogleCloud Messaging, although any other messaging mechanism including email,short messaging service, tweets, and the like may be used as well. Inthe case of APNS, the remote monitor 114 (or a notification messagecenter therein) may establish an Internet Protocol (IP) connection withthe APNS. This connection may be encrypted, persistent, and/oraccredited, so that the notification service can send notificationmessages to the notification message center even when the remote monitorapplication and/or remote monitor are not actively being used. Forexample, the notification message center may alert the user of theremote monitor 114 that a notification message had arrived for theremote monitor application.

In an implementation utilizing a push notification service, thenotification service 112 may receive a notification message from secureserver 110. The notification message may include a destination address,such as a phone number of the remote monitor 114, an IP address, and thelike, and a payload, such as the contents of the notification message.Returning to the previous example regarding low glucose level, thenotification message may include the phone number of remote monitor 114and a short text message, such as a low glucose level value, time ofmeasurement of the value, and/or an identity of the host. Thenotification message may be limited to 256 bytes, although other sizedmessages may be used as well. In any case, the notification service 112pushes the notification message to remote monitor 114 via a connection,such as an Internet Protocol (IP) connection, between the notificationservice 112 and a notification message center at the remote monitor 114.When the notification message center at the remote monitor 114 receivesthe notification message, the notification message center may displaythe notification message, generate a sound, a vibration, and anotherother indication to a user of the remote monitor 114. And, in someexample implementations, the notification message center or a user ofthe remote monitor may activate the remote monitoring application if theremote monitoring application at the remote monitor 114 is not activelybeing used. The notification service 112 may be used in implementationsin which the remote monitor 114 resides on a device, such as a smartphone and the like, that places the remote monitor 114 or theapplications therein in an idle or an inactive mode to conserve power orreduce signaling to/from the network.

In some example implementations, the push notification service may beby-passed, so that the secure server 110 sends the notification messagedirectly to the remote monitor 114 and/or the remote monitoringapplication therein. This may occur, for example, when the remotemonitoring application is open on the remote monitoring device.

When the notification message is received at 192, the remote monitor 114or a remote monitoring application therein may be activated if in anidle mode or an inactive mode. Once activated (which can beprogrammatically or under the control of a user), the remote monitor 114may attempt to establish a connection to secure server 110. For example,the remote monitoring application may not be actively being used (e.g.,in an idle mode, sleep mode, off, in background mode, and the like). Toactivate the remote monitoring application, the remote monitoringapplication may be activated by, for example, opening the remotemonitoring application by selecting and expanding the remote monitoringapplication, actively using the remote monitoring application byentering a value into, selecting an element of, the user interface ofthe remote monitoring application, and the like. Moreover, the remotemonitor and/or remote monitoring application may be activated by otherways as well. For example, activation may be invoked by movement of theremote monitor detected by a motion sensor and/or turning on, orincreasing the intensity, of the display at the remote monitor.

In response to acknowledgement that the remote monitor 114 has activatedthe remote monitoring application via access message 194, the secureserver 110 may send at 196 additional information to the remote monitor.The content of the additional information sent from the secure server110 to the remote monitor 114 may be automatically determined or may bedefined by a request from remote monitor, which may be a requestincluded in the access message 194 or a subsequent message from theremote monitor. The additional information may include one or more ofthe following: all available sensor data not currently stored in thereceiver 102, sensor data over a predetermined amount of time, such asthe previous 3 or 24 hours of glucose data obtained from the sensorsystem 100, receiver 102, and/or secure server 110, a plot of theglucose levels over time, a glucose variability value, instructions,motivational messages, status of host, remote monitoring permissionsmodified by the host, and the like.

In some implementations, the secure server automatically sends sensordata from the past three hours to the remote monitor and the remotemonitor can request any additional amount of past sensor data should theremote monitor want to evaluate the host over a longer period of time.The secure server 110 may query the receiver 102 via gateway 104 foradditional data in order to respond should the secure server not haveall sensor data specified in a request from the remote monitor 114.

To illustrate further, when the remote monitor 114 receives thenotification message, the notification may cause message 132 to appearon a display screen of the remote monitor 114. From the message 132, theremote monitoring application may be activated, either autonomously orunder the direction of a user and/or notification message center. Theremote monitoring application may then access at 192 the secure server110 and programmatically receive any additional information associatedwith the event or other data since the last connection to secure server110. For example, once the notification message is acknowledged with anaccess at 194 or an acknowledgement message, secure server 110 mayautomatically respond with a page having a trend graph of the currentglucose state and information indicating the severity of the event (orany other information available at secure sensor 110). Although thesecure server 100 may instead respond with a subset of the data, inwhich case, the secure server 110 may automatically respond with newdata since the last connection to secure server 110, so that remotemonitor can generate a page including the trend graph showing the last 3hours' worth of glucose levels. In any case, the remote monitor may beconfigured to automatically present, when message 196 is received, thepage showing relevant event information, such as a trend graph coveringa predetermined time period (e.g., a three hour history of glucoselevels) for the host. An exemplary page that can be automaticallypresented is illustrated in FIG. 19, which is discussed in more detailelsewhere in this disclosure.

Although FIG. 3 is primarily discussed with respect to remote monitor114 monitoring a single host for ease of understanding, it is understoodthat the remote monitor may be monitoring multiple hosts, as discussedelsewhere herein. As such, secure server 110 may have sensor data andadditional information associated with other hosts. Accordingly, in someimplementations secure server can automatically send over sensor data ofthe other hosts remote monitor is monitoring, along with the sensor datafrom the host that triggered the notification 190 to the remote monitor.In this manner, remote monitor 114 can have an updated set of sensordata and other information associated with each of the hosts remotemonitor is monitoring.

FIGS. 4A and 4B depict examples of notification messages 170 and 172,respectively. In the example of notification message 170, thenotification message 170 may be presented at remote monitor 114 as awindow requiring a user interaction, when the remote monitor 114receives the notification message. For example, the user interaction maycomprise pressing a button on remote monitor 114, touching the screen ofremote monitor over the area associated with a portion of the message170 or activating (e.g., executing, opening, and the like) the remotemonitoring application at remote monitor 114. In some instances, thenotification message 170 may appear when another application at remotemonitor 114 is actively being used. When this is the case, a userinteraction may comprise touching the screen over the area associatedwith a portion of the message 170 to acknowledge receipt of thenotification message 170 before the user is allowed to resume the otherapplication, although the user action may also preempt the otherapplication and make the remote monitoring application the activeapplication being viewed at the remote monitor. Moreover, the decisionof whether to preempt the other application or resume the otherapplication may be predetermined based on the severity level of theevent, so that relatively more severe events preempt the otherapplication, while less severe events do not.

In the example of notification message 172, the notification message 172may be presented at remote monitor 114 as a message that appears in theuser interface as an informational message not requiring intervention onthe part of the user. Furthermore, when notification message 172 appearswhile another application is being used at remote monitor 114,notification message 172 does not require the user to acknowledgenotification message 172, or even activation of the remote monitoringapplication (which may be idle or inactive state at remote monitor 114),resulting thus in the continued use of the other application by theuser.

FIG. 2B depicts another example architecture of remote monitoring system100. Referring to FIG. 2B, the receiver 102 may incorporate the gateway104 of FIG. 2A. For example, the receiver 102 may include an interface,such as a radio frequency modem, to network 108A. To illustrate further,in the example of FIG. 2B, the receiver 102 may include a smart phone orother processor-based wireless device and provide access to network 108Aand thus secure server 110 via the public land mobile network and othernetworks (e.g., the Internet).

In addition, while illustrated separately in FIG. 2B, the secure server110 may incorporate the notification service 112 or by-pass thenotification service 112 in some implementations. In suchimplementations, the operation of the system at FIG. 2B may be similarto the process described at FIG. 3 but sensor data 180 may be sent at180 directly to secure server 110, and secure server 110 may send anotification message at 188 directly to the remote monitor 114.

FIG. 2C depicts yet another example architecture of remote monitoringsystem 100. Here, gateway 104 is depicted as a dashed box includingseparate devices comprising a docking station 103 and a hostcommunication device 105. Any of the functions for gateway 104 describedherein can be divided between the docking station and host communicationdevice in some implementations. For example, docking station 103 maycommunicate with receiver 102 and host communication device 105 maycommunicate with the secure server 110.

In some implementations, the host communication device 105 is a smartphone and the docking station 103 physically, electrically andcommunicatively couples to receiver 102 to hold, power and communicatewith, respectively, the receiver. In one implementation, the dockingstation 103 couples to the receiver via a USB connection to both providepower to the receiver 102 and communicate with the receiver 102. Thedocking station 103 then communicates with host communication device 105via wireless communication, e.g. using the BLE protocol, and the hostcommunication device communicates to secure server 110 via network 108A.Such an implementation including the docking station 103 may be used inthe case where receiver 102 and host communication device 105 do nothave the capability to communicate directly with one another because,for example, the receiver and host communication device not use acompatible communication protocol.

In an example of the implementation of FIG. 2C, the host communicationdevice 105 is a mobile telephone having a host monitoring applicationdownloaded from the Apple App Store, wherein the application configuresthe mobile telephone to gather information from receiver 102 via dockingstation 103 and transmit that information to secure server 110, as wellas any other functions described herein associated with gateway 104.

Before providing additional implementation examples for gateway 104,networks 108A-C, secure server 110, notification service 112, and remotemonitor 114, the following provides implementation examples for thereceiver 102, continuous analyte sensor 10, delivery pump 2, and/orglucose meter 4.

Referring again to FIGS. 2A-2C, sensor electronics module 12 may, insome example implementations, include electronic circuitry associatedwith measuring and processing data generated by the continuous analytesensor 10. This generated continuous analyte sensor data may alsoinclude algorithms, which can be used to process and calibrate thecontinuous analyte sensor data, although these algorithms may beprovided in other ways as well. The sensor electronics module 12 mayinclude hardware, firmware, software, or a combination thereof toprovide measurement of levels of the analyte via a continuous analytesensor, such as a continuous glucose sensor. An example implementationof the sensor electronics module 12 is described further below withrespect to FIG. 2.

The sensor electronics module 12 may, as noted, couple (e.g., wirelesslyand the like) with one or more devices, such as receiver 102 and thelike, presenting (and/or alerting) information, such as sensorinformation transmitted by the sensor electronics module 12 for displayat receiver 102.

The receiver 102 may include one or more interfaces, such asmachine-to-machine interfaces and user interfaces. For example, the userinterfaces may include a variety of interfaces, such as one or morebuttons 124, a liquid crystal display 122, a vibrator, an audiotransducer (e.g., speaker), a backlight, and/or the like. The componentsthat comprise the user interface may provide controls to interact withthe user (e.g., the host). One or more buttons may allow, for example,toggle, menu selection, option selection, status selection, yes/noresponse to on-screen questions, a “turn off” function (e.g., for analert), a “snooze” function (e.g., for an alert), a reset, and/or thelike. The LCD 122 may provide the user with, for example, visual dataoutput. The audio transducer 230 (e.g., speaker) may provide audiblesignals in response to triggering of certain alerts, such as presentand/or predicted hyperglycemic and hypoglycemic conditions. In someexample implementations, audible signals may be differentiated by tone,volume, duty cycle, pattern, duration, and/or the like. In some exampleimplementations, the audible signal may be configured to be silenced(e.g., snoozed or turned off) by pressing one or more buttons 224 on thereceiver 102 and/or by signaling the sensor electronics module using abutton or selection on the receiver.

Although FIGS. 2A, and 2B depict example implementations of receiver 102as a hand-held display device, other form factors may be used as well,such as a relatively small, key fob-like, dongle-like display device, acellular phone (e.g., a smart phone, a tablet, and the like), a personalcomputer 20, and/or any other user equipment configured to at leastpresent information (e.g., a medicament delivery information, discreteself-monitoring glucose readings, heart rate monitor, caloric intakemonitor, and the like).

In some example implementations, the continuous analyte sensor 10comprises a sensor for detecting and/or measuring analytes, and thecontinuous analyte sensor 10 may be configured to continuously detectand/or measure analytes as a non-invasive device, a subcutaneous device,a transdermal device, and/or an intravascular device. In some exampleimplementations, the continuous analyte sensor 10 may analyze aplurality of intermittent blood samples, although other analytes may beused as well.

In some example implementations, the continuous analyte sensor 10 maycomprise a glucose sensor configured to measure glucose in the bloodusing one or more measurement techniques, such as enzymatic, chemical,physical, electrochemical, spectrophotometric, polarimetric,calorimetric, iontophoretic, radiometric, immunochemical, and the like.In implementations in which the continuous analyte sensor 10 includes aglucose sensor, the glucose sensor may be comprise any device capable ofmeasuring the concentration of glucose and may use a variety oftechniques to measure glucose including invasive, minimally invasive,and non-invasive sensing techniques (e.g., fluorescent monitoring), toprovide a data, such as a data stream, indicative of the concentrationof glucose in a host. The data stream may be raw data signal, which isconverted into a calibrated and/or filtered data stream used to providea value of glucose to a user, such as a host, or a caretaker (e.g., aparent, a relative, a guardian, a teacher, a doctor, a nurse, or anyother individual that has an interest in the wellbeing of the host).Moreover, the continuous analyte sensor 10 may be implanted as at leastone of the following types of sensors: an implantable glucose sensor, atranscutaneous glucose sensor, implanted in a host vessel orextracorporeally, a subcutaneous sensor, a refillable subcutaneoussensor, an intravascular sensor.

Although the description herein refers to some implementations thatinclude a continuous analyte sensor 10 comprising a glucose sensor, thecontinuous analyte sensor 10 may comprise other types of analyte sensorsas well. Moreover, although some implementations refer to the glucosesensor as an implantable glucose sensor, other types of devices capableof detecting a concentration of glucose and providing an output signalrepresentative of glucose concentration may be used as well.Furthermore, although the description herein refers to glucose as theanalyte being measured, processed, and the like, other analytes may beused instead or as well including, for example, ketone bodies (e.g.,acetone, acetoacetic acid and beta hydroxybutyric acid, lactate, etc.),glucagon, Acetyl Co A, triglycerides, fatty acids, intermediaries in thecitric acid cycle, choline, insulin, cortisol, testosterone, and thelike. In some implementations, other health characteristics of a hostare monitored in addition to or instead of analyte monitoring describedherein, including, but not limited to heart rate, blood pressure levels,blood oxygen levels, body temperature, caloric intake, medicamentdelivery and the like.

In one implementation, the sensor system 8 and receiver 102 comprise theDexCom G4® Platinum continuous glucose monitoring system available fromDexCom, Inc., and gateway 104 comprises an Apple iPhone® smartphoneavailable from Apple, Inc. with software downloaded thereon to cause thesmart phone to perform the functions of gateway 104 described herein.

FIG. 5 depicts an example of a sensor electronics module 12, inaccordance with some example implementations. The sensor electronicsmodule 12 may include sensor electronics that are configured to processsensor information, such as sensor data, and generate transformed sensordata and displayable sensor information. For example, the sensorelectronics module may transform sensor data into one or more of thefollowing: filtered sensor data (e.g., one or more filtered analyteconcentration values), raw sensor data, calibrated sensor data (e.g.,one or more calibrated analyte concentration values), rate of changeinformation, trend information, rate of acceleration information, sensordiagnostic information, location information (which may be provided by alocation module 269 providing location information, such as globalpositioning/navigation system information), alarm/alert information,calibration information, smoothing and/or filtering algorithms of sensordata, and/or the like.

In some example implementations, the sensor electronics module 12 may beconfigured to calibrate the sensor data, and the data storage memory 220may store the calibrated sensor data points as transformed sensor data.Moreover, the sensor electronics module 12 may be configured, in someexample implementations, to receive wirelessly calibration informationfrom a device, such as receiver 102, to enable calibration of the sensordata. Furthermore, the sensor electronics module 12 may be configured toperform additional algorithmic processing on the sensor data (e.g.,calibrated and/or filtered data and/or other sensor information), andthe data storage memory 220 may be configured to store the transformedsensor data and/or sensor diagnostic information associated with thealgorithms.

In some example implementations, the sensor electronics module 12 maycomprise an application-specific integrated circuit (ASIC) 205 coupledto a user interface 122. The ASIC 205 may further include a potentiostat210, a telemetry module 232 for transmitting data from the sensorelectronics module 12 to one or more devices, such receiver 102 and thelike, and/or other components for signal processing and data storage(e.g., processor module 214 and data store 220). Although FIG. 2 depictsASIC 205, other types of circuitry may be used as well, including fieldprogrammable gate arrays (FPGA), one or more microprocessors configuredto provide some (if not all of) the processing performed by the sensorelectronics module 12, analog circuitry, digital circuitry, or acombination thereof.

In the example depicted at FIG. 5, the potentiostat 210 is coupled to acontinuous analyte sensor 10, such as a glucose sensor, via data line212 to receive sensor data from the analyte. The potentiostat 210 mayalso provide via data line 212 a voltage to the continuous analytesensor 10 to bias the sensor for measurement of a value (e.g., a currentand the like) indicative of the analyte concentration in a host (alsoreferred to as the analog portion of the sensor). The potentiostat 210may have one or more channels (and corresponding one or more data lines212), depending on the number of working electrodes at the continuousanalyte sensor 10.

In some example implementations, the potentiostat 210 may include aresistor that translates a current value from the sensor 10 into avoltage value, while in some example implementations, acurrent-to-frequency converter may also be configured to integratecontinuously a measured current value from the sensor 10 using, forexample, a charge-counting device. In some example implementations, ananalog-to-digital converter may digitize the analog signal from thesensor 10 into so-called “counts” to allow processing by the processormodule 214. The resulting counts may be directly related to the currentmeasured by the potentiostat 210, which may be directly related to ananalyte level, such as a glucose level, in the host.

The telemetry module 232 may be operably connected to processor module214 and may provide the hardware, firmware, and/or software that enablewireless communication between the sensor electronics module 12 and oneor more other devices, such as receiver 102, display devices,processors, network access devices/gateways, and the like. A variety ofwireless radio technologies that can be implemented in the telemetrymodule 232 include Bluetooth, Bluetooth Low-Energy, the ANT protocol,NFC (near field communications), ZigBee, IEEE 802.11, IEEE 802.16,cellular radio access technologies, radio frequency (RF), infrared (IR),paging network communication, magnetic induction, satellite datacommunication, spread spectrum communication, frequency hoppingcommunication, near field communications, and/or the like. In someexample implementations, the telemetry module 232 comprises a Bluetoothchip, although the Bluetooth technology may also be implemented in acombination of the telemetry module 232 and the processor module 214.Further, while telemetry module is depicted as part of the ASIC 205 inFIG. 2, some or all of the telemetry module can be separate from theASIC in other implementations.

The processor module 214 may control the processing performed by thesensor electronics module 12. For example, the processor module 214 maybe configured to process data (e.g., counts), from the sensor, filterthe data, calibrate the data, perform fail-safe checking, and/or thelike.

In some example implementations, the processor module 214 may comprise adigital filter, such as for example an infinite impulse response (IIR)or a finite impulse response (FIR) filter. This digital filter maysmooth a raw data stream received from sensor 10, data line 212 andpotentiostat 210 (e.g., after the analog-to-digital conversion of thesensor data). Generally, digital filters are programmed to filter datasampled at a predetermined time interval (also referred to as a samplerate). In some example implementations, such as when the potentiostat210 is configured to measure the analyte (e.g., glucose and the like) atdiscrete time intervals, these time intervals determine the samplingrate of the digital filter. In some example implementations, thepotentiostat 210 is configured to measure continuously the analyte, forexample, using a current-to-frequency converter. In thesecurrent-to-frequency converter implementations, the processor module 214may be programmed to request, at predetermined time intervals(acquisition time), digital values from the integrator of thecurrent-to-frequency converter. These digital values obtained by theprocessor module 214 from the integrator may be averaged over theacquisition time due to the continuity of the current measurement. Assuch, the acquisition time may be determined by the sampling rate of thedigital filter.

The processor module 214 may further include a data generator configuredto generate data packages for transmission to devices, such as receiver102. Furthermore, the processor module 215 may generate data packets fortransmission to these outside sources via telemetry module 232. In someexample implementations, the data packages may, as noted, becustomizable and/or may include any available data, such as a timestamp, displayable sensor information, transformed sensor data, anidentifier code for the sensor and/or sensor electronics module, rawdata, filtered data, calibrated data, rate of change information, trendinformation, error detection or correction, and/or the like.

The processor module 214 may also include a program memory 216 and othermemory 218. The processor module 214 may be coupled to a communicationsinterface, such as a communication port 238, and a source of power, suchas a battery 234. Moreover, the battery 234 may be further coupled to abattery charger and/or regulator 236 to provide power to sensorelectronics module 12 and/or charge the batteries 234.

The program memory 216 may be implemented as a semi-static memory forstoring data, such as an identifier for a coupled sensor 10 (e.g., asensor identifier (ID)) and for storing code (also referred to asprogram code) to configure the ASIC 205 to perform one or more of theoperations/functions described herein. For example, the program code mayconfigure processor module 214 to process data streams or counts,filter, calibrate, perform fail-safe checking, and the like.

The memory 218 may also be used to store information. For example, theprocessor module 214 including memory 218 may be used as the system'scache memory, where temporary storage is provided for recent sensor datareceived from data line 212 and potentiostat 210. In some exampleimplementations, the memory may comprise memory storage components, suchas read-only memory (ROM), random-access memory (RAM), dynamic-RAM,static-RAM, non-static RAM, easily erasable programmable read onlymemory (EEPROM), rewritable ROMs, flash memory, and the like.

The data storage memory 220 may be coupled to the processor module 214and may be configured to store a variety of sensor information. In someexample implementations, the data storage memory 220 stores one or moredays of continuous analyte sensor data. For example, the data storagememory may store 1, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 20,and/or 30 (or more days) of continuous analyte sensor data received fromsensor 10 via data line 212. The stored sensor information may includeone or more of the following: a time stamp, raw sensor data (one or moreraw analyte concentration values), calibrated data, filtered data,transformed sensor data, location information, and/or any other sensorrelated or displayable information.

The user interface 222 may include a variety of interfaces, such as oneor more buttons 224, a liquid crystal display (LCD) 226, a vibrator 228,an audio transducer (e.g., speaker) 230, a backlight, and/or the like.The components that comprise the user interface 222 may provide controlsto interact with the user (e.g., the host). One or more buttons 224 mayallow, for example, toggle, menu selection, option selection, statusselection, yes/no response to on-screen questions, a “turn off” function(e.g., for an alert), a “snooze” function (e.g., for an alert), a reset,and/or the like. The LCD 226 may provide the user with, for example,visual data output. The audio transducer 230 (e.g., speaker) may provideaudible signals in response to triggering of certain alerts, such aspresent and/or predicted hyperglycemic and hypoglycemic conditions. Insome example implementations, audible signals may be differentiated bytone, volume, duty cycle, pattern, duration, and/or the like. In someexample implementations, the audible signal may be configured to besilenced (e.g., snoozed or turned off) by pressing one or more buttons224 on the sensor electronics module and/or by signaling the sensorelectronics module using a button or selection on a display device(e.g., key fob, cell phone, and/or the like).

Although audio and vibratory alerts are described with respect to FIG.2, other alerting mechanisms may be used as well. For example, in someexample implementations, a tactile alert is provided including a pokingmechanism configured to “poke” the patient in response to one or morealert conditions.

The battery 234 may be operatively connected to the processor module 214(and possibly other components of the sensor electronics module 12) andprovide the necessary power for the sensor electronics module 12. Insome example implementations, the battery is a Lithium Manganese Dioxidebattery, however any appropriately sized and powered battery can be used(e.g., AAA, Nickel-cadmium, Zinc-carbon, Alkaline, Lithium, Nickel-metalhydride, Lithium-ion, Zinc-air, Zinc-mercury oxide, Silver-zinc, orhermetically-sealed). In some example implementations, the battery isrechargeable. In some example implementations, a plurality of batteriescan be used to power the system. In yet other implementations, thereceiver can be transcutaneously powered via an inductive coupling, forexample.

A battery charger and/or regulator 236 may be configured to receiveenergy from an internal and/or external charger. In some exampleimplementations, a battery regulator (or balancer) 236 regulates therecharging process by bleeding off excess charge current to allow allcells or batteries in the sensor electronics module to be fully chargedwithout overcharging other cells or batteries. In some exampleimplementations, the battery 234 (or batteries) is configured to becharged via an inductive and/or wireless charging pad, although anyother charging and/or power mechanism may be used as well.

One or more communication ports 238, also referred to as externalconnector(s), may be provided to allow communication with other devices,for example a personal computer (PC) communication (com) port can beprovided to enable communication with systems that are separate from, orintegral with, the sensor electronics module. The communication port,for example, may comprise a serial (e.g., universal serial bus or “USB”)communication port, to communicate with another computer system (e.g.,PC, personal digital assistant or “PDA,” server, or the like), a donglewith a wireless transceiver coupled to a docking station as describedfurther below, and/or any other interface. The communication port mayalso be coupled to, or include, a wireless transceiver to allow wirelesscommunications as well. In some example implementations, the sensorelectronics module 12 is able to transmit historical data to a PC orother computing device (e.g., a secure server as disclosed herein) forretrospective analysis by a patient and/or physician.

In some continuous analyte sensor systems, an on-skin portion of thesensor electronics may be simplified to minimize complexity and/or sizeof on-skin electronics, for example, providing only raw, calibrated,and/or filtered data to a display device such as receiver 102 configuredto run calibration and other algorithms described above with respect tothe sensor electronics module 12. However, the sensor electronics module12 may be implemented to execute prospective algorithms used to generatetransformed sensor data and/or displayable sensor information,including, for example, algorithms that: evaluate a clinicalacceptability of reference and/or sensor data, evaluate calibration datafor best calibration based on inclusion criteria, evaluate a quality ofthe calibration, compare estimated analyte values with timecorresponding measured analyte values, analyze a variation of estimatedanalyte values, evaluate a stability of the sensor and/or sensor data,detect signal artifacts (noise), replace signal artifacts, determine arate of change and/or trend of the sensor data, perform dynamic andintelligent analyte value estimation, perform diagnostics on the sensorand/or sensor data, set modes of operation, evaluate the data foraberrancies, and/or the like.

Although separate data storage and program memories are shown in FIG. 5,a variety of configurations may be used as well. For example, one ormore memories may be used to provide storage space to support dataprocessing and storage requirements at sensor electronic module 12.

Although some of the examples noted refer to a continuous analyte sensor10, a glucose meter 4, and pump 2 in communications with sensorelectronics module 12 and/or receiver 102, other devices may be used aswell. For example, sensor electronics module 12 and/or receiver 102 maycouple (either via wired and/or wireless links) to other sensors,including a glucose sensor, an altimeter, an accelerometer, atemperature sensor, a location module (e.g., a global positioning systemprocessor or other source of location information), a heart ratemonitor, a blood pressure monitor, a pulse oximeter, a caloric intakemonitor, a medicament delivery device, and the like.

As noted above, the sensor electronics module 12 may generate andtransmit, via a wireless or wired medium, a data package to a device,such as receiver 102, configured to receive, store, forward/retransmit,and/or display sensor data. The sensor electronics module 12 may, asnoted, analyze the sensor data from the multiple sensors and determinewhich sensor data is to be transmitted based on one or more of manycharacteristics of the host, the receiver 102, a user of the receiver102, a remote monitor 114, and/or characteristics of the sensor data.Moreover, one or more of the functions and/or components describedherein with respect to the sensor system 8 may also or instead be foundone or more of the receiver 102, gateway or secure server 110, and theone or more of the functions described herein with respect to thereceiver 102 may also be found on the sensor system 8.

Referring again to FIG. 2A for purposes of illustration, the receiver102 may forward analyte sensor data, as well as other available data,via wired and/or wireless links to gateway 104. In some exampleimplementations, the gateway 104 may include a network interfaceconfigured as a radio interface, such as a cellular radio interface(e.g., Long Term Evolution and the like), a wireless local area networkinterface (e.g., Wi-Fi and the like), and/or any other type of wirelessor wired interface. For example, the gateway 104 may include at leastone processor including a radio frequency subsystem (e.g., a modem). Inthese wireless examples, when the receiver 102 couples to gateway 104,the gateway 104 sends analyte sensor data and the like wirelessly tosecure server 110 via network 108A, which may include one or more of anaccess network, a wireless local area network, a radio access network, acellular network, the Internet, and/or any other communicationmechanism. In some example implementations, gateway 104 may also includea wired connection network 108A, which further couples to secure server110.

Gateway 104 can automatically send sensor analyte data and additionalinformation from receiver 102 in one or more of a plurality of ways. Forexample, receiver 102 can provide gateway 104 with information without arequest from gateway. The information can be provided automatically,such as after the expiration of a timer or upon the generation of a newsensor data point, or can be responsive to user input to receiver 102.Gateway 104 can then automatically send the information from receiver tosecure server 110. In another example, gateway can automatically requestinformation based upon predetermined rules, such as after the expirationof a timer, such as a 5 minute timer. The information provided by thereceiver 102 can then be automatically sent to secure server 110. In yetanother example, gateway may send a request for information to gateway104 which then forwards the request to receiver 102. The receiver 102can then provide the requested information to gateway, which thenforwards the information to secure server 110. In each of theseexamples, the information requested can be for specific information(e.g., a specific time period of sensor data) or simply a generalrequest to send information. In the latter case, the receiver 102 candetermine what information to send responsive to the request, such asany new sensor data generated by receiver since the receiver lastprovided information to the server 110.

FIG. 6 is a block diagram of an implementation of gateway 104. Thegateway 104 can include a power module 302 for charging the receiver 102when it is coupled to the gateway 104, a wireless network interface 304to allow wireless access to network 108A using a variety of networkaccess technologies, although wired connectivity may also be provided bygateway 104 to network 108A, processor 414 and computer memory forstoring instructions for processor 314 to execute functions of gateway104 and storing health-related information received from receiver 102.

Moreover, the gateway 104 can include a receiver interface 306 toprovide a wired and/or wireless interface to the receiver 102 inimplementations where the receiver is separate from the gateway and thegateway does not include intermediate docking station 103. For example,receiver interface 306 may include a universal serial bus interfacethrough which receiver 102 can communicate with gateway 104, secureserver 110, and the like. The universal serial bus may also provide aphysical connection for charging the receiver 102, although wirelesscharging may be used as well. Furthermore, receiver interface 306 mayinclude a wireless interface, such as Bluetooth, Bluetooth low energy,Zig-bee, Atom, and any other wireless technology, through which receiver102 can communicate with gateway 104, secure server 110, and the like.The gateway 104 may also include a user interface 310, such as adisplay, a touch screen display, a key pad, a speaker, a light emittingdiode, and the like. For example, one or more light emitting diodes maybe used to indicate whether the gateway 104 is properly coupled to thereceiver 102, network 108A, secure server 110, and the like, whether thegateway 104 is connected to a power source (e.g., electrical outlet),whether the battery is charged, and the like. The display may also allowpresentation of sensor data, alerts, notifications, and the like. Forexample, a user interface, such as a display, a light emitting diode,and the like, may provide an indication, such as a specific color lightemitting diode, a message, and the like, representing that a connection,such as an Internet Protocol connection, a secure tunnel, and the like,has been establish between the gateway 104 and the secure server 110, sothat the user of the gateway 104 recognizes that the receiver is coupledto the so-called “cloud” which includes the secure server 110.

As discussed above, in some implementations, gateway 104 can comprise asmart phone having a host monitoring application stored thereon thatconfigures the smart phone to perform the functions of gateway 104described herein.

FIGS. 7A and 7B depict an example of the docking station 700, which canbe the docking station 103 described with respect to of FIG. 2C. FIG. 7Aillustrates a perspective view of the docking station 700 withoutreceiver 102 physically coupled to the docking station, and FIG. 7Billustrates a front view of docking station with receiver 102 physicallycoupled to the docking station. Docking station 700 may have a cavity710 to allow receiver 102 to be slideably inserted and releasably heldinto the docking station. The docking station 700 may also include amechanical mechanism to releasably secure the receiver 102 to thedocking station (not shown). The mechanism can be a latch assembly orthe like. The docking station may electrically couple to the receiver102 via, for example, an electrical connector, such as a universalserial bus connector, and/or a wireless interface, such as Bluetooth,Bluetooth low-energy, Wi-Fi, and any other wireless technology, and maytransmit data received from the receiver 102 to host communicationdevice 105, secure server 110 or remote monitor 114 using an electricalconnector, and/or a wireless interface, such as Bluetooth, Bluetoothlow-energy, Wi-Fi, and any other wireless technology.

The docking station 700 may also serve as a repeater and/or amplifier ofany alert triggered by the receiver 102 and/or secure server 110. Forexample, the docking station 103 may receive an indication of an alerttriggered by the receiver 102 from the receiver. The docking station 700may repeat the alert by, for example, sounding an audible alarm, causinga vibration, and/or lighting a light emitting diode to indicate thealert to a user. Moreover, the receiver 102 may alert using a firstalarm, such as a vibration, while the docking station 700 may re-alertusing a second type of alarm that is different from the first alarm. Forexample, the first alarm can be a vibratory alarm and the second alarmcan be an audible alarm or vice versa. As another example, the firstalarm can be an audible alarm and the second alarm can also be anaudible alarm, but the second audible alarm is louder than the firstalarm and/or has a different tonal pattern.

In some implementations, the docking station 700 can trigger an alert byphysically sensing an alarm from the receiver 102. For example, thedocking station can include a vibratory and/or audible sensor that cansense vibrations or sounds, respectively, emanating from receiver 102.In this way, the docking station 103 can trigger an alert upon sensingthe receiver 102 triggering an alarm while the receiver is docked in thedocking station.

Furthermore, the alert settings at the docking station 700 may be thesame or different as those at the receiver 102. For example, alertsettings at docking station 700 may be more stringent than those at thereceiver 102. For instance, the receiver 102 may have a low glucosethreshold at a value that is greater than a corresponding low glucosethreshold at the docking station 700. The alert settings of the dockingstation 700 can be user configurable using a user interface of thedocking station or a user interface of the host communication device105, for example.

Additionally or alternatively, in some implementations the dockingstation 700 delays triggering an alert that was triggered by receiver102 to allow the host time to cure the alert prior to the dockingstation triggering an alarm. Should the host cure the alert prior to theexpiration of the delay, then the docking station 700 does not triggerthe alert.

Further to FIGS. 7A and 7B, the docking station 700 can include one ormore light indicators, such as LEDs, that indicate a status of thedocking station 700 and/or other components of the system 100. Forexample, a first light indicator 712 can indicate (by either turning onor changing color) if the docking station 700 is receiving power from anexternal power source, a second light indicator 714 can indicate (byturning on, changing color or blinking) if the docking station is pairedto host communication device 105. Other light indicators can be used aswell, such as a third light indicator that indicates if thecommunication channel between docking station 700 and host communicationdevice 105 and/or secure server 110 is open and successfullytransmitting sensor data from receiver 102.

FIG. 8 depicts another implementation of gateway 104. In the example ofFIG. 8, the gateway 104 is configured as a dongle, such as a universalserial bus dongle, including universal serial bus connector 392 forcoupling to the receiver 102, a user interface, such as a button 394 forperforming a Bluetooth pairing to another device, such as host device105, having access to network 108A, or directly to network 108A over aWi-Fi or cellular communication channel. Although the gateway/dongle maybe configured for Bluetooth pairing, the gateway/dongle may supportconnection establishment to the other devices using other radio accesstechnologies, such as Bluetooth low energy, Wi-Fi, Atom, Zig-bee, NFC,and the like. The gateway/dongle depicted at FIG. 8 may also include alight emitting diode 396 for providing an indication of the state of thegateway 104 or receiver 102 (e.g., battery level, glucose level status,whether a user is in a low or high glycemic state, connection status tonetwork, connection status to secure server, and the like). In someexample implementations, the gateway at FIG. 8 may include its ownrechargeable battery to power the gateway and/or the receiver 102,although it may rely on the receiver 102 as a power source as well.

In some example implementations, the gateway 104 may, as noted, includea radio frequency interface to allow the data to be automaticallyuploaded in a compressed format or uncompressed format from the receiver102 to the secure server 110, which may be implemented as a so-called“cloud.” And, the uploading may occur programmatically—without userintervention—when receiver 102 is in communication with gateway 104. Thegateway 104 may also be configured to gather an identifier of thereceiver 102 (or the receiver may automatically provide the identifierwithout a request for the identifier from the gateway 104) and providethe identifier to the secure server 110 to allow the secure server 110to associate the received sensor data with the host 199, receiver, andany previously provided sensor data stored at secure server 110 (or arepository coupled to secure server 110) associated with the host. Insome implementations, the identifier is the serial number of thereceiver 102, and the receiver automatically sends the identifier alongwith any sensor data the receiver provides to gateway. Moreover, in someexample implementations, the gateway 104 may be configured to send dataincrementally, i.e., data previously received would not be re-sent tosecure server 110 unless requested by secure server 110. Furthermore,gateway 104 may select between a cellular connection and a Wi-Ficonnection based on connection speed, cost, and the like. For example, afree Wi-Fi connection may be selected over a fee-based cellularconnection if available. Further, a cellular connection may be used forsending substantially real-time data generated by sensor system 8, but aWi-Fi connection used for sending historical data, as it may not be asimportant for sending historical data in a timely fashion in someimplementations.

In some example implementations, the gateway 104, receiver 102, sensorsystem 8, and remote monitor 114 may be preconfigured, so that when thesensor system 8 and receiver 102 communicatively couple to gateway 104,the gateway 104 recognizes the sensor system/receiver and/or usersthereof. Further, the remote monitor 114 may also be recognized byserver 110 to allow remote monitoring of receiver 102 to occur withlittle (if any) configuration by an end-user/host of receiver 102. Forexample, the secure server 110, gateway 104, receiver 102, sensor system8, and remote monitor 114 may be preconfigured and preregistered, withlittle, if any, configuration or registration effort on the part of thehost.

Referring again to FIGS. 2A-2C, the network 108A may include a wirelessaccess network, such as a cellular network, a wireless local areanetwork, and the like. In addition, network 108A may couple to othernetworks as well. For example, the gateway 104 may couple to an accessnetwork served by a base station or a Wi-Fi access point, which may havebackhaul links to other networks including the public land mobilenetwork, the Internet, and the like. Networks 108B-C may be implementedin a manner that is the same or similar to network 108A.

The secure server 110 may receive analyte sensor data, store analytesensor data, process analyte sensor data to detect events and thus allowgeneration of notifications to remote monitors 114 and/or generation ofalerts to receiver 102 and/or gateway 104, generate pages or reports fordisplay at remote monitor 114, receiver 102 and/or gateway 104, allowregistration and/or configuration of host 199, sensor system 8, receiver102, gateway 104 and remote monitor 114.

In some example implementations, one or more entities may have remotemonitors 114A-114M. For example, the secure server 110 may register theidentity of the users of remote monitors 114A-114M and a schedule forwhen each entity performs monitoring. Moreover, one or more of theentities may be configured at the secure server 110 as primary monitorsfor receiving notifications, while other entities may be configured asbackup, secondary monitors for receiving notifications when a primarymonitor does not acknowledge, or act on the, notification message sentto a remote monitor 114 according to one or more predefined rules.Furthermore, the secure server 110 may include one or more rulesdefining when an event results in a notification to one or more of theremote monitor(s) 114.

The secure server 110 may also provide a cloud-based diabetes datamanagement framework that receives patient-related data from variousdevices, such as a medical device, a glucose meter, a continuous glucosemonitor, a sensor system, a receiver, and/or other devices (e.g., adevice providing food consumption, such as carbohydrates, consumed by ahost or patient, medicament delivery data, time of day, temperaturesensors, exercise/activity sensors, and the like) including any devicedisclosed herein. Furthermore, the cloud-based diabetes data managementsystem may receive data programmatically with little (or no)intervention on the part of a user. The data received from devices,receivers, source systems, and the like may be in a variety of formatsand may be structured or unstructured. For example, the secure server110 may receive, from sensor system 8 and receiver 102, raw sensor data,which has been minimally processed or analyzed, and the received data isthen formatted, processed (e.g., analyzed), and/or stored in order toenable report generation by secure server 110. In addition to sensordata, the secure server 110 may also receive data from source systems,such as health care management systems, patient management systems,prescription management systems, electronic medical record systems,personal health record systems, and the like.

In some example implementations, the secure server 110 may checkreceived data for transmission-related errors, data formatting,device-related error codes, validity of the data, duplicate data points,and/or other aspects of the data. Moreover, if out-of-range data pointsor device errors are found, the secure server 110 may identify thosedata points by, for example, flagging those data points, subsequentlycorrecting the identified data points programmatically or by a systemadministrator, and storing the corrected data points. Moreover, secureserver 110 may be configured by a user, such as a clinician, doctor, andthe like, to perform additional data processing steps, such ascorrecting time of day, correcting the date, and analyzing data byspecific cohorts, groups, and relationships (e.g., demographics, such asage, city, state, gender, ethnicity, Type I diabetes, Type II diabetes,age of diabetes diagnosis, lab results, prescription drugs being used,self-reported conditions of the patient, diagnosed conditions of thepatient, responses to questions posed to patient, and any other metadatarepresentative of the host/patient). Once secure server 110 performsinitial data processing (e.g., checks, cleaning, and analysis), theprocessed data and/or the raw data may be stored at a repository coupledto the secure server 110.

The processing at secure server 110 may also include associatingmetadata with the data received from the devices and/or sensors.Examples of metadata include patient information, keys used to encryptthe data, patient accelerometer data, location data (e.g., location ofpatient or location of patient's clinic), time of day, date, type ofdevice used to generate associated sensor data, and the like. Thepatient information can include the patient's age, weight, sex, homeaddress and/or any past health-related information, such as whether thepatient has been diagnosed as a Type 1 or Type 2 diabetic, high-bloodpressure, or as having any other health condition.

The processing may also include one or more of the following: analysis,such as determining one or more descriptive measurements; detecting orpredicting events (e.g., a hypoglycemic, a hyperglycemic, and/or anyother feature detected in the sensor data); applying pattern detectorsto the received sensor data; and generating reports based on receivedinformation, such as sensor data, and descriptive measurements of theinformation including sensor data. The descriptive measurements mayinclude statistics (e.g., median, inner, and outer quartile ranges,mean, sum, n, standard deviation, and coefficients of variation). Insome example implementations, secure server 110 may also associatemetadata with the data received from the devices, sensors, sourcesystem, and/or receivers; determine one or more descriptivemeasurements, such as statistics (e.g., median, inner and outer quartileranges, mean, sum, n, and standard deviation); generate reportsincluding descriptive measurements; validating and verifying theintegrity of the received data from the devices, sensors, source system,and/or receivers; processing received data based on metadata (e.g., toselect certain patients, devices, conditions, diabetic type, and thelike), and/or correlating received data from the devices, sensors,source system, and/or receiver, so that the data can be compared andcombined for processing including analysis. Moreover, the results of anyprocessing performed by secure server 110 may be used to generate one ormore reports, such as graphs, bar graphs, static charts, charts, and thelike. Furthermore, the reports and other outputs generated secure server110 may be provided to receiver 102, remote monitor 114, and any otherprocessor via one or more delivery mechanisms.

Secure server 110 may be considered secure in the sense that it keepsprivate, patient identifiable information and/or restricts access tousers registered and thus authorized to use secure server 110. Forexample, secure server 110 may receive a request from a device, such asreceiver 102 or remote monitor 114, to perform an action (e.g., providedata, store data, analyze/process data, request a report, requestconfiguration information, request registration, and the like). Beforesecure server 110 services the request, the secure server 110 mayprocess the request to determine whether the request is authorized andauthenticated. For example, an authenticator and authorizer maydetermine whether the sender of the request is authorized by requiring auser to provide a security credential (e.g., a user identifier, apassword, a stored security token, and/or a verification identifierprovided by text message, phone, or email) at a user interface presentedon a processor, such as receiver 102, remote monitor 114, and/or anyother computer. If authorized, authenticator and authorizer mayauthenticate the sender of the request to check whether a securitycredential associated with sender of the request indicates that thesender is indeed permitted to access a specific resource at system 100in order to perform the action, such as store (or upload) data at arepository, perform analyze/process data, request report generation,receive alerts, receive notification messages, and the like.

In some example implementations, the secure server 100 may include apattern detector to perform pattern detection on data, such as sensordata representative of blood glucose data, analytes, and other data aswell (e.g., insulin pump data, carbohydrate consumption data, and thelike). The pattern detector may detect the pattern and generate anoutput, which may be provided to a report generator at secure server forgenerating an alert to receiver 102, a notification message to remotemonitor 114, and/or a page containing a report.

Moreover, the pattern detector may detect patterns in data/sensor dataretrospectively for a predetermined time defined by system 100 and/or auser. For example, the pattern detector may receive input data from arepository coupled to secure server 110, and the input data may includesensor data representative of glucose concentration data, analytes, andother data as well (e.g., insulin pump data, carbohydrate consumptiondata, histograms and/or counts, data from a continuous glucose monitor(CGM data), time of day, amount of carbohydrates, other food relatedinformation, exercise, awake/sleep timer intervals, medicationsingested, and the like). Moreover, the input data may comprisehistorical data obtained over a timeframe, such as 8 hours, 1 day, 2days, 7 days, 30 days, and/or any other time period. For example, theinput data may comprise counts representative of monitored analytedetection levels (e.g., glucose concentration levels) received andstored at system 100 over a period covering a four-week timeframe.

To further illustrate the pattern detector, patterns can be recognizedbased on one or more predefined triggers (also referred to as criteria,rules, and filters). Furthermore, the one or more predefined triggersmay be variable and adjustable based user input and/or programmaticallybased on one or more rules at the secure server 110. And, some types ofpatterns may be selected, turned off and on, and/or modified by a user,a user's physician, or a user's guardian, although system 100 mayselect, adjust, and/or otherwise modify triggers programmatically aswell.

Some examples of the types of relationships in the input data that canbe considered a pattern are one or more of the following: a glucoselevel that exceeds a target glucose range (which may be defined by auser, a health care provider, secure server 110, or a combinationthereof); a glucose level that is below a target glucose range; a rapidchange in glucose level from a low to a high (or vice versa); times ofday when a low, a high, an at range, or rapid glucose level eventoccurs; days when a low, a high, an at range, or a rapid glucose levelevent occurs; a hyperglycemic pattern; a hypoglycemic pattern; patternsassociated with a time of day or week; a weighted scoring for differentpatterns based on frequency, a sequence, and a severity; a customsensitivity of a user; a transition from a hypoglycemic to hyperglycemicpattern; an amount of time spent in a severe event; a combination ofglucose change and time information; and/or a pattern of highvariability of glucose data. Further, a pattern may be based on acombination of previous pattern data and a currently detected situation,whereby the combined information generates a predictive alert.

Hypoglycemic patterns by time of day may be detected based on eventsdetected by secure server 110. For example, a pattern may be identifiedin situations where the user has low glucose concentrations around thesame time in the day. Another type of pattern, which may be identified,is a “rebound high” situation. For example, a rebound high may bedefined as a situation where a user overcorrects a hypoglycemic event byoverly increasing glucose intake, thereby going into a hyperglycemicevent. These events may be detected based on one or more predefinedtriggers.

To further illustrate examples of the patterns, basic patterns may beconfigured to allow a search for certain patterns in the data, such asvalues within range, high coefficient of variance, and the like. Eachpattern may have one dimension, such as within range, with a separatepattern looking specifically for below range, another looking for lowcoefficient of variance, and the like. Each pattern may be statisticallybased and use standard descriptive statistics in the application ofpattern matching. Each pattern may be assigned scores for various rulesencoded with each pattern, such as is it positive, negative, howimportant an insight is, and the like. Each pattern may also be assigneda possible set of date ranges for which the pattern is applicable. Forexample, counting the number of times a high glucose value is followedby a low below range is a pattern that just applies to the full range.However, looking at high levels of variance can apply to a month, aweek, a day, an intraday, every other hour, hourly, and combinationsthereof. Every pattern may be assigned a minimally acceptable scorebefore it can be considered for display or generation of an alert sentto the receiver 102 (or host 199) and/or notification message sent toremote monitor 114. Each pattern (and any associated triggers/rules) maybe processed for a set of data for a certain timeframe, and if thepattern is applied and meets certain minimal requirements, then thepatterns are ranked according to significance. As such, the rankedpatterns may each correspond to an alert sent to the receiver 102 (orhost 199) and/or notification message sent to remote monitor 114 (or aprimary monitor or secondary monitor access the remote monitor 114).

Connection establishment refers to the process of adding one or moreremote monitors to system 100 to provide a second layer of oversightinto the operation of sensor system 8 and receiver 102. The connectionsto the remote monitor 114 may be established based on an invitation sentto the remote monitor 114. This invitation may be sent with the consentof the receiver 102, gateway 104 (e.g., via a user interface therein),and/or host 199. For example, the receiver 102 and remote monitor 114may be required to both accept invitations or to enter a code (e.g., apassword, shared secret, and the like) in order to opt in to the remotemonitoring provided at system 100.

To illustrate further with respect to FIG. 1, host monitoring system198A may have a single remote monitor 114A or a plurality of remotemonitors 114A-114M, and the rules associated with when the remotemonitors receive alerts and what types of alerts should be sent may bestored at the secure server 110. For example, first remote monitor 114Amay receive notification messages during the day, while second remotemonitor 114B may receive notification messages at night, although otherschedules may be used as well. As another example, first remote monitor114A may have high and low threshold values that trigger an alert toremote monitor 114A that are different than one or both of the high andlow threshold values that trigger an alert to remote monitor 114B.Moreover, one or more rules may define first remote monitor 114A as aprimary monitor, while second remote monitor 114B may be defined as abackup or secondary monitor.

The remote monitor 114 may acknowledge a received notification messageby activating (e.g., opening, interacting with, accessing, selecting,and the like) the remote monitoring application which causes a messageto be sent at 194 (FIG. 3) to the secure server 110 or responding to amessage presented at the user interface of the remote monitor. If thesecure server 110 does not receive any form of acknowledgement that theuser has seen or otherwise acknowledged the notification message at theremote monitor after a predetermined amount of time (which may depend onthe severity or type of the event), the secure server 110 may resend thenotification to the remote monitor 114. In some example implementations,the secure server 110 may receive a message from the notificationservice 112 that the remote monitor 114A is out of service or otherwiseunreachable, in which case the secure server 110 may resend thenotification message to a different remote monitor 114B. The delay usedby the secure server for resending the notification messages may beconfigured based on the severity or type of the event, and the secureserver may also include rules defining a predetermined quantity ofunsuccessful resends before escalation to another primary monitor, asecondary/backup monitor, an emergency medical service, and the like.And, this predetermined quantity of unsuccessful resends may also beconfigured at the secure server to vary based on severity or type of theevent or user configured.

In some example implementations, as illustrated in FIG. 1, the remotemonitor 114 may receive notification messages for a single hostmonitoring system 198A or a plurality of host monitoring systems198A-198N. Furthermore, a page may be generated by secure server 110 andthen sent to the one or more remote monitors for presentation at a userinterface at each of the remote monitors, although the secure server 110may instead send the data to the remote monitor 114 to enable pagegeneration at the remote monitor 114. The page may include a textualand/or a graphical indication of the status of the one or more hostsbeing monitored. To illustrate, a school nurse may have a remote monitor114 with a page depicting each of the host monitoring systems 198A theremote monitor is monitoring. Each remote monitoring system 198A-198Nmay be associated with a student. In this example, the page may have thestatus information for each of the students, the most recentnotification message for each of the students, a graphical or a textualindication that the student is within limits, or an indication that thestudent is above limits, and the like. Each student may be associatedwith a cell (a defined space on the display). As such, the nurse mayquickly view the user interface and see the status of each of thestudents being monitored. A graphical indication may be used to visuallyconvey the overall status of each student in each student's cell. Forexample, a so-called “smiley” face icon may indicate the student'sglucose levels are within limits and a so-called “sad” face icon mayindicate the host's glucose levels are of concern because they are abovea threshold. Moreover, in some example implementations, the page may bepresented on a display, so that a selection (e.g., touch on a touchscreen, mouse over, click, etc.) of a cell, notification or face iconresults in additional information being provided to the remote monitor.For example, selecting a cell of a student may cause the remote monitor114 to access the secure server 110 and then receive additionalinformation, such as one or more of current and prior glucose levels,patient information, and the like, and update the display page ortransition to a new display page that displays information about theselected student in more detail (e.g., displaying a trend graph of thestudent's glucose level over the past three hours). Although theprevious example refers to glucose levels and specific types of messagesand icons, other types of events, messages, and icons discussed hereinmay be used to convey the status of a host.

In some example implementations, the page discussed above may beconfigured as a so-called “dashboard” including dynamic content. Forexample, the icons for the host-patients requiring the greatest care orattention (e.g., the patients with glycemic levels that are extremelyhigh or low) may be arrange in the top row of page to allow the remotemonitor to quickly ascertain the state of riskier host patients.Although the previous arrangement described using the top row of thepage to segregate some of the so-called riskier host-patients othersegregation schemes may be used (e.g., different colors, intensities,and/or locations on the page). Furthermore, the page may be considereddynamic as the patients segregated for extra attention may change overtime causing the page to depict different icons for different patientsin the segregated top row of the page. Examples of dashboards arediscussed in greater detail with respect to FIGS. 18A and 18B.

Designating Remote Monitors

In some example implementations, an entity, such as a user, may bedesignated by secure server 110 as a primary monitor. When this is thecase, the primary monitor at remote monitor 114 may not be available dueto for example a dead battery of the remote monitoring 114A, a deviceout of service, a lack of radio reception, and the like. A secondarymonitor may thus be designated by secure server 110 to receive thenotification message, which would otherwise be sent to the primarymonitor. The secondary monitor may have access to another remotemonitoring device 114 and thus receive the notification message, whenthe first notification message to the primary monitor is not received oracknowledged within a predetermined amount of time. The amount of timecan be variable based on the severity or type of event. In addition tomonitoring acknowledgements from the remote monitor 114, the secureserver 110 may access the quality of service mechanisms at thenotification service 112 to determine whether the remote monitor 114device is not in service (e.g., due to a failure, a dead battery, out ofrange, or otherwise not accepting notification messages) to enable thesecure server 110 to select another monitor that is in service.

Escalation

The remote monitor 114 may, in some example implementations, generate amessage for presentation requiring some form of acknowledgement oraction by the user of the remote monitor 114 (e.g., a primary orsecondary monitor) to confirm receipt of a notification message. Theacknowledgement or action may comprise responding to the notificationmessage, opening a remote monitoring application at the remote monitor114, and the like. Moreover, if the action is not performed within apredetermined amount of time, the secure server 110 may determine thatthe user of the remote monitor has not seen (or otherwise been notifiedby) the notification message. When this is the case, the secure servermay escalate the notification message to another remote monitor asdefined by one or more rules at the secure server. The secure server mayalso check the push notification service (or quality of servicemechanism therein) to see if the notification message has beendelivered. If not, the secure server may determine that the user of theremote monitor has not seen the notification message and use this as abasis to escalate the notification message to another remote monitor.

In some implementations, the secure server 110 may include one or morerules defining an escalation sequence defining which notificationmessages should be sent to primary first remote monitor 114A and, givenan out of service state, when the messages should be resent to one ormore other remote monitors 114B-114M. During configuration of the remotemonitors 114A-114M, the secure server 110 may be configured via userinput (e.g., the host and/or one or more of the remote monitors) howand/or when each of remote monitors 114A-114M is to be notified in anescalation sequence. This escalation sequence configuration may bedefined by a user or provided as a default setting (which may bereconfigurable or adaptable over time based on the responsiveness of theuser/host/monitor) and may vary based on severity of the event and typeof event. For example, the escalation sequence may define rules definingwhen to alert a host-patient at a receiver 102, when to escalate to aprimary monitor at a remote monitor, when to escalate to a secondarymonitor at a remote monitor, and/or when to escalate to an emergencymedical service or 911-emergency response.

In some example implementations, the escalation rules may be differentfor each of the remote monitors 114A-114N and/or different from thethresholds set for the host monitoring system 198. For example, a firstrule may define that if a glucose value exceeds a first threshold value,the secure server 110 should send an alert to first remote monitor 114A.The secure server 110 may include a second, separate rule that definessending a notification message to a second remote monitor 114B when theglucose value exceeds a second threshold value, and yet another thirdrule that defines sending another notification message to a third remotemonitor 114M when the glucose value exceeds a third threshold value. Inaddition, a rule may define sending a notification to more than oneremote monitor, such as all remote monitors or a subset of the remotemonitors monitoring a host. The rules may be configured by a user (e.g.,using receiver 102, gateway 104, workstation 22, etc.) or provided asdefault settings (which may be reconfigurable by a user).

Furthermore, if a user at the receiver 102 does not acknowledge an alertwithin a predetermined amount of time, an escalation sequence may alsobe implemented. For example, referring to FIG. 2A, the secure server 110may determine (e.g., by monitoring sensor data received from receiver102 and knowing the thresholds on the receiver) that receiver 102alerted (or should have alerted) host 199, where the alert required anacknowledgement. The acknowledgement can be in the form of a userresponding to a message presented on a user interface 122 of receiver102, or the user otherwise curing the alert, such as taking an actionthat can be measured by a device associated with the host-user (e.g.,medicament pump 2 indicating that insulin has been administered to theuser, an analyte measurement indicating that the underlying cause of thealert is no longer a problem because measured level above a threshold ortrend moving in a desired direction, etc.). In this example, if thesecure server 110 does not receive some form of acknowledgement and/oran indication of the underlying event that triggered the alert is curedafter waiting a predetermined amount of time, the secure server 110 mayresend the alert and/or send a notification message to a primary remotemonitor, a secondary remote monitor, and/or an emergency medicalservice. And, this escalation, including the retries and delay, may beconfigured at the secure server 110 to vary based on the severity and/ortype of event triggering the alert.

Reminders

In some example implementations, the secure server 110 may include rulesproviding a so-called “follow-up” reminder. For example, if a host-userat receiver 102 has not taken an action, such as take insulin, drink aglass of juice, etc., the secure server 110 may send a remindernotification to the remote monitor 114 and/or to the receiver 102 and/orgateway 104 after a predetermined amount of time. The predeterminedamount of time and which of the one or more of remote monitors114A-114M, receiver 102, gateway 104 associated with a reminder may beconfigurable and may vary based on severity of the event and/or type ofevent.

Furthermore, in some implementations, the secure server 110 may re-sendnotifications repeatedly (e.g., every 5 minutes or any other time) toremote monitor 114 and/or receiver 102 until the receipt of thenotification message is acknowledged. In some example implementations,the secure server 110 may configure different alarm types to betriggered by the receiving device (e.g., remote monitor 114 or receiver102) as each re-send is sent to the receiving device (e.g., successivelyincreasing volume, brightness, or vibration with each repeated,unacknowledged notification message, or triggering a vibratory alarmwith a first reminder and a vibratory alarm with a second reminder,etc.). Opening a message from the secure server 110 at receiving devicemay serve as an acknowledgment, as well as other actions detectable bythe secure server.

In some example implementations, a user designated as a primary monitormay signal to secure server 110 an inability to provide monitoring bysending a message to secure server 110 and/or receiver 102, using, forexample, remote monitor 114A or workstation 22. When this is the case,the secure server 110 may demote the primary monitor to a secondary (orbackup monitor) and promote one of the secondary monitors to a primarymonitor. The secure server may have rules defining which of thesecondary monitors may be promoted or each of the secondary remotemonitors may be polled to assess availability to assume the role ofprimary remote monitor. And, the secure server 110 may send a message(via notification service, for example) to the secondary monitor thathas been promoted to a primary monitor that it has been designated as aprimary monitor (and send a corresponding message to a demoted primarymonitor).

To assure quality of service with respect to the receipt by the remotemonitors of notification messages, one or more operations may beperformed to mitigate the potential loss of a notification message sentto remote monitor 114. For example, if notification service 112comprises a push notification service (e.g., Apple Push NotificationServer, Google Cloud Messaging Server, and the like) and thenotification service cannot be contacted (or a connection cannot beestablished between secure server 110 and notification service 112), thesecure server 110 may send notification via another mechanism, such aseparate a short message service (SMS) message directly to the remotemonitor 114, a phone call, an email, or any other mechanism to establishcontact with the remote monitor(s) and/or the users associated withthose remote monitoring devices.

Registration/Invitations for Remote Monitoring

As noted above, in some example implementations, the devices used atsystem 100 may be required to register with the secure server 110. Toillustrate with respect to FIG. 2B, the receiver 102 (which may beimplemented on a processor-based wireless device, such as a smart phoneor a tablet computer) may send a message via the public land mobilenetwork or other network(s) to invite remote monitor 114 to accept aconnection establishment request from secure server 110. If accepted,remote monitor 114 may be provided with notification messages for eventsassociated with receiver 102 and access to sensor data and reportsassociated with host 199. Although the previous example describes thereceiver 102 sending an invite to remote monitor 114, other devices,such as secure server 110, gateway 104, user communication device 105,workstation 22, and/or remote monitor 114, may send invitations as wellor instead, depending upon the implementation.

In some example implementations, the receiver 102 may send a pluralityof invitations to a plurality of remote monitors 114A-114M. Moreover,the invitations may be managed by the receiver 102, gateway 104, usercommunication device 105 and/or secure server 110, so that at any giveninstant of time, a user can monitor the status of invitations, such ashow many invitations have been sent, how many have been accepted, howmany have been rejected, and the identity of any primary and secondaryremote monitors. For example, receiver 102 gateway 104, usercommunication device 105 and/or secure server 110 may manage theinvitations, so that at any given instant, a quantity of remote monitors114A-114M does not exceed a threshold amount (e.g., 5 or 10 remotemonitors).

Moreover, the receiver 102, gateway 104, user communication device 105and/or secure server 110 may also manage the quantity of remote 114monitors based on location and/or time, so that a host-user has apredetermined quantity of remote monitors 114 at any given locationand/or any given time.

In some example implementations, a host 199 or caretaker of host maymanage the status of invitations (e.g., invitation sent, invitationaccepted, monitoring cancelled, and the like) via receiver 102, gateway104, user communication device 105 and/or secure server 110. Forexample, one or more user-interactive pages may be presented on acomputer display (e.g., of receiver 102, gateway 104, user communicationdevice 105, or workstation 22, etc.) including the status of theinvitations (e.g., whether invitation pending, denied, or accepted).These one or more pages may be configured to allow changes to the rulesassociated with the remote monitors 114A-114M. For example, changes maybe made to the rules used to trigger notification messages, thedesignation of primary monitors (including time and locationdesignations), the designation of secondary monitors (including time andlocation designations), the escalation sequence and escalation thresholdsettings, and the like. In addition, the page(s) may provide a list ofremote monitors from which a user can designate primary and secondaryremote monitors and send invitations to any selected monitors. Thepage(s) may allow configuration of permissions, such as whether a remotemonitor 114 is authorized to receive one or more of notificationmessages, authorized to view patient data (e.g., sensor data includingcurrent and/or past data), and the like.

FIG. 12 depicts an example invitation page 500 presented at a remotemonitor 114 in the form of an email message. In this example, a user,“John Doe,” associated with a sensor system 8 and receiver 102 hasinvited remote monitor 114 to be a monitor as indicated by theinvitation at 502. Moreover, the invitation may include instructions forthe remoter monitor, which in this example includes clicking on a linkat 504 to allow a download of the remote monitor application code fromsecure server 110 or another server (e.g., iTunes server operated byApple, Inc.) and accepting the invite at 506 (which sends an acceptancemessage to secure server 110). The remote monitor may also be given theoption to not accept the invitation to monitor by selecting auser-selectable decline icon 508, which may notify secure server 110 ofthe decline indication.

To register an invited remote monitor 114 with the secure server 110,the remote monitor and the receiver 102 may each input a value, such asa code, a shared secret, a link (e.g., a uniform resource locator), apassword, or a combination thereof, to allow connection establishmentand thus enabling remote monitor 114 to receive notification messagesfor events associated with receiver 102 and to have access to sensordata and reports at secure server 110. Moreover, a user, such as host199, may access an Internet browser using workstation 22 of FIG. 1, forexample, to access secure server 110 and login to view and manage theone or more devices granted remote monitoring privileges.

In some example implementations, one or more of the devices of remotemonitoring system 100 (e.g., remote monitor 114, receiver 102, gateway104, user communication device 105, or workstation 22) may need a code,such a prescription code provided by a health care provider, in order toregister with secure server 110. The code may expire after apredetermined time and/or may be limited to a predetermined number ofuses (e.g., a single use code that can be used once to register withsecure server 110 to obtain a remote monitor code). Furthermore, thecode may also define at the server 110 a configuration for the devicebeing registered as a remote monitor 114, such as permissions (e.g.,whether can receive notifications, view past sensor data and/or viewcurrent sensor data) of and/or alert settings associated with the remotemonitor.

In some example implementations, the secure server 110 may haveconfiguration information defining the identity of the receiver 102 andremote monitor 114, so that a user, such as host 199, may access secureserver 110 and then add one or more devices, such as receiver 102 andremote monitor 114 to the user's system. The remote monitor 114 mayquery secure server 110 to obtain information regarding which hosts (orreceivers) the remote monitor is allowed to monitor and the secureserver can configure the remote monitor 114 accordingly. In some exampleimplementations, the notification messages sent to the remote monitor(s)may be configured to suit the needs of a given remote monitor-user andthese needs may be different from the needs of the host-patient.Accordingly, the rules dictating the sending of a notification messageto remote monitor 114 may be different from a rule used to trigger analert to the receiver 102 being used by the host-patient.

The following provides an illustrative example of a caregiver usingremote monitor 114 as part of host-patient care with reference to FIG.2A. Specifically, the caregiver may be administering an analyte therapyto the host-patient. For example, the caregiver may be a parent of ayoung child. In this example, a parent may want to receive notificationmessages, which are identical to the alerts, sent to the receiver 102(or triggered by the receiver) and host-patient (which in this exampleis a child). Moreover, the secure server 110 may obtain the receiver 102settings through the gateway 104. During the configuration of the remotemonitor 114, the secure server 110 may prompt the parent to select a setof rules that are identical to those being used by the child's receiver.In this example, any subsequent changes made to the set of rules beingused for the child's receiver would be programmatically propagated tothe set of rules being used to send notifications to the parent's remotemonitor 114. Although the previous example described the same set ofrules being used from the host and monitor, the host and monitor mayimplement different rules as well.

The following provides another illustrative example of a host-patientadministering treatment but in this case, the host-patient or caregivermay not want a high degree of oversight of the host-patient. To thatend, the caregiver at remote monitor 114 may want the host-patient toreceive an alert first, but allow the patient-host time to act on thealert to correct or acknowledge the event prior to an alert being sentto the caregiver. As an example, an alert triggered by the receiver 102may indicate a hypoglycemic or hyperglycemic event, and if after acertain period of time the host-patient has not taken one or morepredetermined action(s) to remediate the event (as evident by subsequentglucose measurement indicating the same or worsening patient state, forexample), the caregiver at remote monitor 114 may receive a notificationmessage responsive to the event. That is, if a patient-host usingreceiver 102 does not respond or acknowledge an alert in a predeterminedmanner, the caregiver at remote monitor 114 may then receive anotification message. The caregiver at remote monitor 114 may thusreceive a notification message when the host patient at receiver 102fails to respond to, or acknowledge, certain, real time events, such asa low glucose event (which may be considered severe as the host-patientmay be incapacitated or unaware of the event so a notification to theremote monitor is in order). However, the secure server 110 eitherdelays sending reminders or stops sending reminders responsive to anotification message if one or more predetermined occurrences areidentified by the secure server. The one or more predefined occurrencescan be curing the underlying event triggering the alert, acknowledgingthe alert or taking a defined action, such as administering insulin andthe like (which causes data to be sent to the secure server a remotemonitor.

Further, the secure server 110 may be configured with a delay to waitfor an acknowledgement or action before notifying the remote monitor114, and this delay may vary based on the type and/or severity of thecondition causing the alarm, and vary depending upon default or userconfigured settings of the remote monitor. In addition, the secureserver 110 may be configured to also monitor data from the receiver 102even after an acknowledgement message is received from the receiver 102in response to an alert. For example, the secure server 110 may receivethe acknowledgement message (which may be a message sent by receiver102), but secure server 110 may wait a predetermined time for sensordata from the receiver 102 confirming that the host-patient has indeedtaken action. Again, this delay may vary based on the type and/orseverity of the condition causing the alarm.

The following provides yet another illustrative example of ahost-patient administering treatment but in this case, the host-patientis highly independent so the remote monitor may only be triggered in anemergency. For example, the secure server 110 may include a rule totrigger a remote monitor in the case of an emergency, such as a severehypoglycemia event occurring at night. In this scenario, thehost-patient may not be able to respond to the alert of the event, sothe secure server 110 may trigger a notification message if the glucosefalls to an extremely low level for a period of time or the user doesnot respond after a period of time to the very low glucose alert sent toreceiver 102. And, the period of time may be varied based on the typeand/or severity of the condition causing the alarm.

The following provides another illustrative example of a host-patientthat is highly independent but is hypoglycemia unaware and has notrusted sources for emergency response. In this use case, thehost-patient may select a remote monitor 114 associated with anemergency medical service so as to automatically notify the service inthe event of a severe hypoglycemic event when the glucose falls to anextremely low level for a period of time or the user does not respondafter a period of time to the very low glucose triggered by receiver102.

Managing Remote Monitor Alert Settings

In some example implementations, a user may manage the alerts for eachof remote monitors 114A-114M monitoring a host 199. For example, thehost 199 can use host monitoring system 198 to invite remote monitor114A to be a monitor and configure the permissions at secure server 114using receiver 102, gateway 104 (including host communication device),or workstation 22. The permission may be specific to one or more certainalerts or global in the sense that all the alerts for remote monitor114A may be manipulated by the user. Although the previous exampledescribes the permissions being set by a user, the permissions may bedetermined programmatically as well.

To manage alerts, a user may access secure server 110 using a computingdevice, such as remote monitor 114, receiver 102, gateway 104, hostcommunication device 105 or workstation 22, and manage the alerts by forexample setting alerts, changing thresholds, turning alerts on or off,and the like. FIG. 13 depicts an example page 600 that may be presentedon a display of the host computing device. The page 600 may allowchanges to alerts for a certain remote monitor 114A. In the example ofFIG. 6, a low glucose alarm 602 may be turned on 610, and the threshold604 that defines the threshold configured by the user. FIG. 6 alsodepicts that delay 606 may be managed using page 600 as well. Forexample, the delay 606 may define how long the secure server 110 waitsbefore sending a notification message from the secure server (vianotification service) to the remote monitor 114A if the host's glucoseconcentration remains below the low threshold. In this example, thedelay is zero seconds, but can be changed using page 600 to be anotheramount of time, such as 5, 10, 15 or 30 minutes, or an hour. Page 600also allows secure server 110 and/or notification service 112 to triggersending reminders 612 and vary a time 606 associated with triggering thereminders. For example, the reminders represent the amount of time thatelapses before the secure server 110 triggers another notification toremote monitor 114A if remote monitor has not acknowledged the alert orif the host has not cured the event that originally triggered the alert.In this example, if a user fails to acknowledge an alert or takecorrective action within 30 minutes after an original notificationresponsive to a reading below 70 mg/dl, the secure server 110 sendsanother notification regarding the low glucose level to the remotemonitor 114A. Although the example described with respect to FIG. 6refers to a low glucose value, a delay, and a reminder, any other aspectof the alerts for a remote monitor 114 described elsewhere herein can belikewise managed as well, such as high glucose level alerts, high rateof change alerts and the like.

In addition, while the above description with respect to FIG. 6 refersto managing alerts for a remote monitor 114, a similar page can be usedby receiver 102, gateway 104 or host communication device 105 to managealerts triggered by host communication device in the implementations ofFIGS. 2a -2C. As an example, host communication device 105 can displaypage 600 for managing alerts by host communication device independentfrom receiver 102. In this way, host communication device 105 canfunction as a secondary alert device for host 199.

In some implementations, a user may modify one or more rules definingalerts representative of events associated with the analyte state of thehost. A user may use a computing device, such as remote monitor 114,receiver 102, gateway 104, host communication device 105, or workstation22, to modify the alert settings, such as low glucose level thresholdsand the like, of the host monitoring system 198. In this way, a parent,for example, can modify the settings of their child's remote monitoringsystem 198.

Although the previous example refers to modifying low glucose alarms,the modification may include varying a first threshold associated with alow level of glucose at the host, varying a second threshold associatedwith a high level of glucose at the host, varying a delay between whenthe message is triggered by the receiver 102, varying a time valuebetween when a reminder message is sent, and any other alert that may betriggered for a host monitoring system 198 or remote monitor 114.

Moreover, the secure server 110 may adapt the set of rules used for ahost-patient. For example, the set of rules for a remote monitor 114 maybe predetermined based on some basic host-patient demographics. Afterinitial use of remote monitoring system 100, secure server 110 mayprogramically adjust thresholds used to trigger some or all events.These adjustments may be made for a variety of reasons. For example,thresholds, such as glucose levels, glucose rates of changes, and thelike, used to determine when to trigger an event may be adjusted toreduce the frequency of some alerts and/or notifications as a remotemonitor 114 receiving too many messages may decide to ignore themessages. The thresholds may also be adjusted to tighten the range of apatient's glucose variation during the day in order to decrease thevariability in a host's day-to-day glucose variability.

In some example implementations, data management tools and CGM analysesmay be used to help patients better manage their diabetes or assistclinicians in enhancing recommendations. As CGM data (and/or analytedata) may be provided to secure server 110 in about real time, the datamay be used by case managers in payer systems and/or medical systems toenhance ongoing diabetes management. However, it may be impractical fora diabetes case manager to review the resulting so-called “big data.” Assuch, filters may be used to allow exception based reporting of use orglycemic patterns to promote efficient use of the case manager's time byidentifying specific issues. To that end, one or more patterns may bedefined at the secure server to identify the issues requiring theattention of the case manager. The patterns may include longitudinalanalysis or comparisons between time periods. These patterns may alsoidentify high-risk patients, such as those with frequent or severe lows,frequent or severe highs, and/or marked glucose variability. This may beconsidered particularly important for use with patients on intensiveinsulin therapy, with hypoglycemia unawareness, poor control, those newto insulin, and the like. The patterns may also identify therapynon-responders identifying, such as those with sustained hyperglycemia,suggesting non-response to therapy or worsening of control, suggestingnon-adherence, disease progression, or tachyphylaxis. This may beconsidered particularly useful when new medicaments are added or therapyis optimized. The patterns may also identify responders ornon-responders linked to diabetes education or by particular providersor consultants.

In some example implementations, additional performance information maybe gathered at the secure server 110 from patients at a plurality oflocations. This additional information may be used to evaluateenvironmental factors that could influence and affect the sensor'sperformance. Rather than gathering and analyzing information solely froma single host-patient, data may be gathered at the secure server andthen compared on a macro level spanning across a plurality of hostpatients and/or across a plurality of geographic locations (or regions).In essence, the sensor system's 8 overall effectiveness may be evaluatedbased upon various environmental factors being monitored. For example,data gathered in real time from across the United States or even theWorld may show if temperature, humidity, altitude, or the like influencethe sensor system's 8 performance and thus provide an indication as towhether the sensor system 8 and/or sensor 10 should be replaced orrepaired. Moreover, the secure server 110 may also process receivedsensor information and identify patterns (e.g., by lot number, region,or the like), and additional algorithms, calibration information orfail-safes may be uploaded based on these identified patterns to improvethe sensor accuracy and/or performance.

In some example implementations, the secure server 110 mayprogrammatically track product performance and utilization of a sensorsystem including sensor 8 and/or receiver 102. For example, the sensorsystem and/or receiver may programmatically provide to secure server 110information identifying the sensor (e.g., lot number) and summarizingits performance. The performance metrics may include accuracy, on time,data capture, and the like. Moreover, if one or more sensor performancemetrics fall outside of an expected range, then secure server 110 mayrequest additional information to be transmitted from the sensorsystem/receiver to the secure server to allow classification of thefailure mode. For example, the secure server 110 may send alerts and/ornotifications to receiver 102, gateway 104 and/or remote monitor 114that the sensor system 8 and/or receiver 102 needs to be maintained(e.g., replaced, repaired, calibrated, and the like) based on determinedperformance information. And, the secure server 110 may also beconfigured to send, based on the performance information, alerts ornotification messages indicating that the sensors requires a reset, anew calibration value is needed, or a new sensor should be ordered. Thedata provided to the secure server 110 may be configurable and stored ata repository coupled to the secure server 110.

Moreover, sensor system tracking by the secure server may includetracking the performance of the receiver's wireless interface. Forexample, if a hardware error (or any detected error condition) occurs,information related to the error may be transmitted to the secure server110. The data transmitted may also be used to track feature utilization,which may include alert settings, number of screen visits, and the like.In addition, this data may be used to collect and manage data duringclinical studies. Furthermore, the sensor data transmitted to the secureserver 110 may also be expanded to tracking of patient performance ofglycemic control. When this is the case, performance metrics may includethe “time spent” in different glucose ranges, amplitudes of glycemicexcursions, insulin dose information, and the like. For example, duringa continuous glucose monitoring (CGM) session, data may be automaticallytransmitted to a secure server 110 and/or a coupled repositoryaccessible to the host-patient and/or the patient's clinical careprovider. Accordingly, the above-noted automatic tracking of productperformance and classification of failure modes may, in some exampleimplementations, provide more accurate information regarding productperformance, facilitate resolving sensor issues experienced by patients,and automate product replacement (or shipment) when the sensorperformance is deemed ready for replacement.

In some example implementations, the secure server 110 may provide aclosed control loop. Specifically, secure server 110 may send a messageto receiver 102, which responds to secure server 110. Moreover, secureserver 110 may send messages to remote monitor 114, which responds tosecure server 110. Accordingly, secure server 110 may request an actionfrom receiver 102 and/or remote monitor 114, and receive acknowledgementfrom receiver 102 and/or remote monitor 114, when the action iscompleted, forming thus a closed loop. The receiver 102 may include oneor more aspects of the functions provided by the remote monitor 114, andremote monitor 114 may include one or more aspects of the functionsprovided by the receiver 102.

Example Host Monitoring System Set-Up Process 1000

FIG. 10 is a flow chart depicting process 1000 for setting up hostmonitoring system 198 in accordance with some implementations. Forillustrative purposes, the setup process 1000 will be discussed withreference to the remote monitoring system architecture illustrated inFIG. 2C, although it is understood that setup process 1000 can beapplied to the architecture of FIG. 2A or FIG. 2B with changes toaccommodate the differences of architectures.

Additionally, for further ease of understanding, the followingcomponents of FIG. 2C are used in one example of process 1000: thesensor system 8 and receiver 102 make comprise a DexCom G4 Platinumcontinuous monitoring system, available from DexCom, Inc., where thesensor 10 is a DexCom G4 sensor, the sensor electronics module 12 is aDexCom G4 transmitter, and the receiver is the DexCom G4 receiver; thereceiver 102 is docked in the docking station 103 as illustrated anddiscussed with reference to FIG. 7B; the host communication device 105comprises an Apple iPhone available from Apple, Inc.; and each remotemonitor 114A-114M comprises an Apple iPhone or other mobile phone havingan iOS® (commercially manufactured by Apple, Inc.), Android®(commercially manufactured by Google, Inc.) or Windows® (manufactured byMicrosoft, Inc.) based mobile operating system.

At block 1000, a user downloads a host monitoring application on to thehost communication device 105. (It is understood in the host monitoringapplication can be downloaded onto gateway 104 the implementation ofFIG. 2A or downloaded onto receiver 102 in the implementation of FIG. 2Bthe host monitoring application can be, for example.) In someimplementations, the host monitoring application is downloaded from aserver, which can be independent (e.g., operated by a different entity)of secure server 110, such as the Apple App server operated by Apple,Inc. However, in some implementations, the host monitoring applicationis downloaded from server 110. The host monitoring application comprisesinstructions for the host communication device 105 to perform the hostcommunication device functions described herein, such as gatheringsensor data from the receiver 102 via the docking station 103, transmitthe sensor data to the secure server 110, manage alerts of hostmonitoring system 198, inviting users to become remote monitors of host,manage remote monitor settings, pairing with the docking station 103and/or receiver 102, and the like.

Once the host monitoring application is downloaded to the hostcommunication device 105, a user can open the application (e.g., byselecting an icon associated with the host monitoring application on ahome screen of the host communication device) and uses the applicationto create an account at block 1012. In addition to storing accountinformation on the host communication device 105, the account is createdand stored on secure server 110. In some implementations, creating theaccount includes entering user identifying information, such as name andemail address, a password, and a unique identifier associated with thereceiver 102, such as the receiver's serial number. As discussed belowin block 1016, the receiver's serial number can be used for pairing thereceiver 102 and/or docking station 103 with the host communicationdevice 105, as well as other functions.

FIG. 9 illustrates an exemplary page 900 host monitoring application candisplay to a user at the account setup block 1012 to facilitate entry ofthe serial number of the receiver 102 or other unique identifier. Here,the page 900 is an illustration of the location of the serial number toaid the user in finding the serial number of entry. Page 900 alsoprovides an alphanumeric entry field where the user can select tomanually enter the serial number. In addition, page 900 providesselectable icons 902 and 904 that allow the user to take a photo of theserial number using a camera of the host communication device 105 andscan in the serial number using a bar code scanner of the hostcommunication device 105, respectively.

At block 1014, the user uses the host monitoring application to managealert settings for the host communication device 105. The hostapplication can initially present default alert settings, where the usercan modify the default user settings using the user interface of thehost communication device 105. In some implementations, the alertsettings comprise repeating one or more alerts on the receiver 102. Thisway, the host communication device 105 can amplify (e.g., trigger adifferent type of alarm than the receiver, such as a louder alarm)and/or echo alarms of the receiver (e.g., only sounding the alarm aftera predetermined amount of time from the alarm of the receiver if theevent triggering the alert on the receiver has not been cured). Thealert settings can also include turning off or on alerts for variousevents.

The user pairs the host communication device 105 with the dockingstation 103 at block 1016. In some implementations, to pair the hostcommunication device 105 with the docking station 103, the user powerson the docking station and connects the receiver 102 to the dockingstation. At this point, the host communication device 105 and thedocking station 103 begin a pairing and authentication procedure.

In some implementations, the docking station 103 does not have a displayand thus conventional pairing and authentication procedures may not beadequate. Thus in some implementations, receiver 102 provides a serialnumber to the docking station 103 and a user enters the receiver serialnumber into the host communication device 105. The host communicationdevice 105 can then transmit the serial number (or encrypted version ofthe serial number) to the docking station to establish an authenticatedcommunication channel.

The following pairing and authentication procedure may be used in someimplementations. In response to the receiver 102 being docked to thedocking station 103, the docking station derives an authentication tokenfrom the receiver's serial number (which the receiver transmits to thedocking station) and puts it in a Generic Attribute Profile (GATT)characteristic. The docking station 103 then broadcasts a generaladvertisement to bond. The host communication device 105 device looksfor the advertisement. After discovering the docking station 103, thehost communication device 105 connects and performs a service discovery.The host communication device 105 then attempts to read the GATTcharacteristic mentioned previously. The docking station 103 respondswith an insufficient authorization message (pairing and encryption isrequired). The host communication device 105 then prompts the user topair with the docking station 103. Both the docking station 103 and thehost communication device 105 compromise a long term key to use forencryption and are then paired. The host communication device 105 thenreads the token from the characteristic mentioned above, and using thischaracteristic, verifies the authenticity of the docking station 103.The host communication device 105, which has previously derived its owntoken from the receiver serial number entered previously into the hostcommunication device in block 1012, writes this token to a GATTcharacteristic in the docking station 103. The docking station 103 thenuses this token to verify the authenticity of the host communicationdevice and, if authentic, enters a persistent bonded state.

Using the above-mentioned pairing and authentication process, if the twodevices (receiver 102 and docking station 103) are disconnected at anypoint, the docking station 103 directs an advertisement for connection.

At block 1018, the user uses the application on the host device 105 toinvite remote monitors 114. Here, the application may prompt the userfor identifying information of a potential user of a remote monitor,including a name and email address accessible from a device capable ofbeing a remote monitor 114, such as a mobile smart phone or tabletcomputer. In addition, the application can prompt the user forpermissions that the user wants the remote monitor 114 to have, such aspermission to view trend graph data, and alert settings that the userwants the remote monitor 114 to have. Once finished, the applicationsends an invitation to the remote monitor 114, with the information inthe invitation, such as identifying information, permissions and alertsettings stored on secure sever 110. The user can invite additionalremote monitors using the above described invitation procedure. In someimplementations, the application can include a page that lists thestatus of all invitations sent by the user.

Note that process 1000 can be implemented using a setup wizardimplemented by the host monitoring application on host monitoring device105 to guide the user through the setup process 1000.

Example of Remote Monitor Set-Up Process 1600

FIG. 16 is a flowchart of an exemplary process of remote monitoringusing remote monitor 114. Similar to process 1000, FIG. 16 will bedescribed for illustrative purposes only with respect to the remotemonitoring system 100 architecture of FIG. 2C.

At block 1610, a user receives on a computing device, such as a smartmobile phone, an invitation to become a remote monitor. An exampleinvitation is illustrated and discussed in more detail with respect toFIG. 12. In some implementations, a user receiving the invitation caneither accept or deny the invitation by selecting an accept icon or denyicon, respectively, in the email. Denying the invitation ends process1600, whereas accepting the invitation moves process 1600 to block 1620.

At block 1620, the invitation programically directs the user via theuser's computing device to download a remote monitoring application, ifthe user accepts the invitation. In some implementations, accepting theinvitation at block 1610 programically triggers the user's computingdevice to automatically access a server carrying the remote monitoringapplication. The server can be the App Store operated by Apple, Inc. inthe case that the user's device is an Apple mobile device. The user thendownloads the remote monitoring application onto the computing device.

Note that in some implementations, the user of the remote monitor 114need not register with secure server 110, as the secure server alreadyhas the user's account information from when the invitation was formedin block 1012 of process 1000 (FIG. 10).

At block 1630, the user manages alert settings using the remotemonitoring application downloaded on the computing device (nowconsidered a remote monitor 114). The alert settings can initially beset at recommended alert settings set by the person that sent theinvitation at step 1012 in process 1000 (or default settings in the casethe person sending the invitation did not enter any recommendedsettings) in some implementations. The user of the remote monitor 114can then modify any of the recommended or default settings. The settingscan include setting threshold values for when to trigger an alert to theremote monitor, delays, reminders and no data alert settings, discussedin more detail elsewhere herein. The remote monitor 114 may thentransmit the settings of the remote monitor to the secure store forstorage and use when triggering alerts associated with the remotemonitor.

At block 1640, the remote monitor 114 monitors hosts' analyte levels aspermitted. The monitoring can include monitoring a plurality of hostsusing the remote monitor, as discussed in more detail with respect toFIG. 1. The monitoring can include receiving notifications triggered bysecure server 110 and sent via notification service 112 and viewingsensor data accessible from secure server. For example, in someimplementations, a user can activate the remote monitoring applicationon remote monitor 114 to view a dashboard page of a plurality of host'sglucose levels.

Example Invitation to Become Remote Monitor

As discussed above in block 1610 of FIG. 16, a user can receive aninvitation to remotely monitor host 199. In some implementations, theinvitation is the form of an email, such as that depicted in FIG. 12.The user can accept or deny the invitation using the email. The user canaccept the invitation by indicating that the user wants to install theremote monitoring application by selecting selectable text 504, or denythe invitation by selecting selectable text 508. If the user denies theinvitation, then the remote monitoring system 100 can notify the hostthat sent the invitation of the denial by sending a notification viaserver 110 and/or notification service 112 to communication device 105,for example. However, if the user accepts the invitation, then theremote monitoring system 100 can notify the host of the acceptance bysending a notification via server 110 and/or notification service 112 tocommunication device 105, for example, and process 1600 continues toblock 1620.

In some implementations, a receipt accepting the invitationautomatically sets up a remote monitoring account on server 110. Thatis, the recipient need not log in and create an account, as the hostprovided account creation information (recipient name, email, phonenumber and the like) for the recipient when generating the invitation.Further, the host can include a picture of the host during theinvitation creation process so that the invitation includes a picture ofthe host in the vitiation sent to the recipient (which can help therecipient know the invitation is valid) and the picture of the host canbe used as the picture of the host in the remote monitor (such as on adashboard as discussed with reference to FIGS. 18A and 18B andelsewhere).

The invitation can include a single use token which the recipient of theinvitation can use to accept the invitation without requiring therecipient to log into the remote monitoring system, in someimplementations. The toke can be in the form of a Globally UniqueIdentifier (GUID). The invitation may also include a timestamp of whenthe invitation was sent and when the invitations expires.

System Status View

In some implementations, a user of remote monitoring system 100 may notreadily know if the remote monitoring system 100 is working or why thesystem may not be working. For example, in the implementation of FIG.2B, a host 199 may not realize that data is not being transmitted fromthe sensor system 8 to the server 110, or even if the host realizes thatdata is not being transmitted, the host my not recognize where theproblem lies so that data transmission can resume. Accordingly, someembodiments provide a system status page the help a user understand ifthe system is working correctly, and, if not, what the source of theproblem may be.

FIGS. 11A and 11B are exemplary views of a status page 1100 inaccordance with some implementations. Status page 1100 includes a statusbar 1110 that includes representations of various components of remotemonitoring system, which in this example, includes docking station 1114,host communication device 1118 and server 1112, and the communicationchannels between each of the components, such as a near-filed wirelesscommunication (Bluetooth®) channel between the docking station and thehost communication device, and a communication channel (e.g. Wi-Fi orcellular) between the host communication device and the server 1112. Thestatus bar can indicate where connections are working and whereconnections are not working. For example, if a connection is determinedto be working, then the connection can be graphically displayed in afirst state, and if the connection is not working then the connectioncan be graphically displayed in a second, different state. The firststate and the second state can be, for example, a different color (e.g.,green if working, red if not working) and the like. Further, eachportion of the status bar, 1114, 1116, 1118, 1120 and 1122 can be userselectable, where if a user selects a particular portion, the hostmonitoring application can display help information (in the form of apop-up message or new display screen, for example) that can help a userresolve issues associated with the portion selected by the user. Forinstance, if the user selects the docking station icon 1114, the remotemonitoring application can display a message asking the user to makesure the docking station is plugged in, for example.

Status page 1100 can also include a character icon 1132 that displays anoverall status of the system. In the example of FIGS. 11A and 11B, thecharacter icon 1132 is in the form of a monster holding a sign. Theappearance of the character icon 1132 can change based on the status ofthe system so a user can quickly determine the status by viewing thecharacter icon. For instance, character icon 1132 can have a smilingexpression and holding a sign with a check mark to indicate the systemis working and transmitting sensor data, as illustrated in FIG. 11A. Incontrast, the character icon 1132 can have a frowning expression andholding a sign with an X to indicate the system is not working, asillustrated in FIG. 11B. The eyes of the character icon 1132 can alsohelp indicate to a user if the system is working, such as the eyesblinking if host monitoring application is working, or the eyes notblinking if the eyes aren't blinking. The blinking of the eyes can alsocorrespond to the transmission rate between the docking station 103 andthe host communication device.

Host monitoring application can also display a status tab 1124 on statuspage 1100 and any other pages displayed by host monitoring application,as illustrated in FIGS. 11A and 11B. Status tab can be part of a menuthat includes a plurality of different selectable tabs associated withdifferent display pages of the host monitoring application that, whenselected, display the associated display page The tabs in FIGS. 11A and11B additionally include a follower tab, 1126, account tab 1128 and moretab 1130. Notably, the status tab can always display an indication ofthe connection state of the system, such being displayed in green andwith a check mark, as illustrated in FIG. 11A, if the system is working,or in red and with an X, as illustrated in FIG. 11B, if the system isnot working. The status tab can be displayed regardless of the currentpage being displayed, thereby providing the user with an indication ofthe status of the system regardless of the page being displayed.

In some implementations, host monitoring system 198 may be configured toperiodically send messages to server 110. If the server detects a lackof messages from the host monitoring system 198 for a predeterminedamount of time, then the server can trigger a notification to be sent tothe host monitoring system (such as receiver 102, gateway 104 or hostcommunication device 105) notifying the host of the lack of messages sothat the host can check to determine if the host monitoring system isworking, using for example status page 1100.

Host Monitoring Control Pages

Host monitoring application can also include various display pages thatallow the user to view statuses of remote monitors and configurepermissions and settings associated with remote monitors.

FIG. 14 illustrates an overview page 1400 in accordance with someimplementations. Over view page can include a plurality of cells 1402a-1402 e, each cell associated with a remote monitor or potential remotemonitor. Each cell can include a name 1410 a-1410 e associated with theremote monitor for identification purposes. The cells 1402 a-1402 e canalso be displayed according to a status of the remote monitor. Forexample, cell 1402 a is grouped under a removed by remote monitor(referred to as a follower in FIG. 14) status 1404 a, cell 1402 b isgrouped under an expired invitation status 1404 b, cell 1402 c isgrouped under an active status 1404 c, cell 1402 d is grouped under aninvited status 1404 d, and cell 1402 e is grouped under a not sharingstatus 1404 e. Not that a plurality of cells can be displayed under eachgroup; FIG. 14 merely illustrates one cell for ease of explanation ofthe different statuses.

Page 1400 also includes a selectable help icon 1406 a-1406 e associatedwith each group status. By selecting a help icon, the host monitoringapplication can provide further information to a user that explains whatthe associated status involves. The help information can be displayed ina pop-up window for example.

Icons can also be displayed in a cell that illustrate permissions and/orenabled functions associated with that remote monitor. For instance,icons 1412 and 1414 indicate that remote monitor associated with cell1402 c has notifications enabled and has permission to view trend graphinformation associated with the host being monitored.

Selectable tabs can also be provided in each cell. For example, FIG. 14illustrates removal tabs 1408 a and 1408 b that remove the cell from thepage when selected by a user. Arrow tabs 1416 c-1416 e can be used toprovide further information about the remote monitor associated withthat cell. For example, selecting a selectable arrow 1416 can cause thehost monitoring application to transition to settings display page thatprovides more detail about the associated remote monitor and the remotemonitor's settings.

An exemplary settings display page 1500 is illustrated in FIG. 15 inaccordance with some implementations. Settings display page 1500 caninclude identification information, such as a name 1502 and emailaddress 1504 associated with the remote monitor, permissions of theremote monitor and notification settings of the remote monitor. In theexample of FIG. 15, the permissions can include a trend graph permission1504 tab that a user can use to toggle between allowing and denying. Ifpermitted, remote monitoring system 100 allows that remote monitor toview trend graph information of the host 199 and, if denied, then theremote monitor cannot view the trend graph information of the host.Notification settings allow the user of host monitoring application toview the current notification settings of the associated remote monitor.The notification settings can include an urgent low notification alert1506, a low notification alert 1508, a high notification alert 1509 anda no data notification alert 1510, and each alerts associated status(e.g., associated threshold values and whether the alert is off or on).In some implementations, a user using host monitoring application canmodify the remote monitors' settings using page 1500, for example, butin other implementations some or all of the settings can only bemodified by the remote monitor, as indicated in FIG. 15.

Display page 1500 can also allow a user of the host monitoringapplication to pause and cancel the capabilities of remote monitormonitoring the host. A pause/resume control button 1514 can selectablystop and re-start remote monitoring capabilities of the remote monitor,such as stopping and starting notifications being sent to the remotemonitor and/permission for the remote monitor to view sensor data of thehost. Such a function can be useful in instances where a host does notalways want a remote monitor to be monitoring the host. A specificexample can include a baby sitter as a remote monitor. It may bedesirable for the baby sitter to have remote monitoring capabilitieswhen caring for a child being monitored by the host monitoring system,but stop the remote monitoring when the baby sitter is no longer caringfor the child. This way, a new invitation need not be sent to the babysitter each time the baby sitter cares for the child.

A delete Remote Monitor control button 1516 can be used to delete theremote monitor from the list of remote monitors that can monitor thehost. In contrast to the pause/resume control 1514, deleting a remotemonitor using the delete control 1516 would necessitate the host tore-invite the person to become a remote monitor in some implementations.As discussed elsewhere herein, remote monitoring system may have apredefined limit to the number of remote monitors that can monitor ahost, thus it may be become necessary for the host to delete the remotemonitor so that the host can add another remote monitor in someimplementations.

In some implementations, remote monitoring system 100 sends anotification message to a remote monitor that has had its permissions orsettings changed, or has been paused, resumed or canceled. This way, theremote monitor is aware of the change and is not relying on the previousconfiguration.

In addition, each of the pause, cancel, and resume functions may beconfigured globally across all of a host-patient's monitors instead ofor in addition to individual monitors as described above. In the case ofa global function, control buttons can be provided on page 1400 of FIG.14, for example, where pressing the control button implements thefunction globally across all remote monitors monitoring the host.

Remote Monitoring Dashboard View

As discussed elsewhere herein, the remote monitor 114 can provide aso-called dashboard view of hosts it is monitoring. FIGS. 18A and 18Bare two different implementations of dashboard page 1800 in accordancewith some implementations. The dashboard 1800 can include a plurality ofcells 1802 a-1802 d, each associated with a different host. Each cell1802 can include identifiers of the host, such as a name of the host anda picture of the host 1804 a-1804 d.

In the implementation of FIG. 18A, each cell lists a current status ofthe cell, such as a time 1812 a when the displayed analyte value 1806 awas measured, a statement 1812 b whether the host is using the remotemonitoring system 100, a statement 1812 c whether the hosts hostmonitoring system is working, or a statement 1812 d indicating that theremote monitor has been paused, for example.

In the implementation of FIG. 18B, the cells 1802 can be grouped on page1800 according to the status of the cell, such as removed 1814 by thehost (referred to as Sharer in FIG. 18B), active 1818 (i.e., system isconnected and providing data of the associated host to the remotemonitor), disconnected 1824 (i.e. system is not connected, e.g., becausereceiver 102 is not in docking station 103 in the implementation of FIG.2B) and not sharing 1826 (i.e. the host has paused the remote monitor).Further, cells within a group can be ordered by severity of themonitored condition or other criteria, as discussed elsewhere herein.

Cells 1802 can also include an indication of the permissions and/orsettings of the remote monitor associated with that host. For example, atrend graph icon 1810 can indicate that the remote monitor haspermission to view a trend graph of sensor data of that host.

Cells 1802 that are in the active group 1818 can also includeinformation about the health condition being monitored. For example thecell 1802 can display the most current analyte concentration value 1806a that was provided to remote monitor and an trend arrow 1808 aindicating a rate of change of the measured analyte. Further informationcan also be provided in the cell, such as a time associated with themeasurement of the displayed analyte concentration or if data has notbeen received from the host monitoring system.

User selection of a cell 1802 can also cause the remote monitor totransition to another display page that provides additional informationabout the host associated with that cell. For example, the remotemonitor can transition to a trend graph display (FIG. 19) associatedwith that host or a settings page (FIG. 17) associated with that host.

Trend Graph View

FIG. 19 is an exemplary page that provides a trend graph 914 of a host'smonitored analyte concentration in accordance with some implementations.The trend graph can display a trend line 1916 of measured analyteconcentrations, as well as low and high thresholds 1918 and 1920 thatare used for alerting either the remote monitor 114 or the hostmonitoring system 198. The trend graph page can also include auser-selectable slider bar that allows a user to select different timeframes of sensor data to view, such as three, six, 12 and 24 hour views.A picture of the host 1904 and name of the host 1902 can also beprovided so that a remote monitor is not confused as to the individualbeing monitored in case the remote monitor is monitoring a plurality ofdifferent hosts.

In some implementations, the page of FIG. 19 can automatically bedisplayed when the remote monitoring application is initially openedresponsive to a user directly opening the application and/or a useropening a remote monitoring notification on remote monitor 114 sent byserver 110 or notification service 112, as discussed elsewhere wherein.

Remote Monitor Settings Page

FIG. 17 is an implantation of a settings page 1700 that can allow theremote monitor to configure remote monitoring settings of a host.Settings page can include a picture filed that displays a picture of thehost 1506 and a name field that displays a name of the host, both ofwhich can be modified by the remote monitor using the settings page1700. The settings page also includes settings for variousalert/notification settings, such as an urgent low alert 1706, low alert1714, high alert 1724 and not data alert 1736. The function of each ofthese alerts is discussed elsewhere herein. As illustrated in FIG. 17,the settings associated with each of these alerts can be modified, suchas turning the alert on or off, the threshold value(s) associated witheach alert and an alert sound associated with each alert.

Automatic Detection of New Receivers and Registration

In some implementations, receivers 102 need to be associated with a host199 so that when glucose data gets to server 110, the data can beassociated with the host. Accordingly, remote monitoring system 100 canassign a receiver to a host. This can initially be done through thepairing process discussed above with respect to block 1016 of FIG. 10.If a host receives a new receiver, to make a friendly user experienceand prevent errors, the host monitoring application can see that adifferent serial number is being used, check with the server 110 to seeif this is a new receiver or if this receiver is already owned byanother host and asks the host via communication device 105 if this istheir receiver and allows them to take ownership or it gives them anerror telling them that it is already owned.

Accordingly, an exemplary detection of a new receiver process can be asfollows. First, the host communication device 105 if a new receiver isbeing used by validating with server if the receiver is owned by someoneelse (via comparison of receiver serial numbers to a database, forexample). If the server determines that no one else owns the receiver,then the host monitoring application asks if the user if he or she wantsto make that receiver theirs. If yes, then the receiver and the datafrom that receiver are associated with that host.

Loss of Data Alert

In some example implementations, the secure server 110 may include arule to automatically trigger a notification message or anothercommunication mechanism (e.g., a phone call, short message servicemessage, and the like) to a remote monitor 114 if data has not beenreceived from host monitoring system 198 for a predetermined amount oftime. This way, a user of remote monitor 114 can be aware that somethingmay be wrong with host monitoring system 198 and attempt to contact thehost.

Location-Based Alerts

In some example implementations, the secure server 110 may use thelocation of the receiver 102, gateway 104, host 199, and/or remotemonitor(s) 114 when determining whether to send a notification messageand/or determine destination of a notification message. For example,when a host-patient is in a first location and travels to a secondlocation, the secure server 110 may, based on rules, select a firstremote monitor 114A near the first location and, when the host-patentmoves to the second location, select a second remote monitor 114Blocated near that second location. Location may also be used to varyalerts and notifications. For example, the secure server 110 may varythe rules used to trigger an alert or notification based on thehost-patient's location. Location may be used in combination with timeas well, so the secure server 110 may vary thresholds associated withalerts and notifications based on location and time of day.

Acknowledgement Notifications

In some example implementations, the receiver 102 or gateway 104 maypresent a prompt (e.g., message, window, etc.) at a user interfacerequiring the host-patient to acknowledge the triggered alert and/orindicate what corrective action was taken in response to the alert. Theprompt may include a list of options that the user can select (e.g.,administered insulin, consumed carbohydrates, and the like) to indicatethe corrective action that was taken. A notification message may be sentdirectly to one or more remote monitors 114, or through the secureserver 110 and/or notification service 112, to the remote monitor(s), sothat the remote monitors are aware that the patient has acknowledged thealert and/or that corrective action taken (and/or a description of thecorrective action).

In addition, remote monitor 114 can allow a user to select from aplurality of pre-written messages to send to host monitoring system. Auser can select the notification, whereupon the remote monitor displaysa list of pre-written text messages that the user can select from tosend to the host monitoring system. The messages can be selected byremote monitor to be relevant to the underlying cause that triggered thenotification message. For instance, if the notification message wastriggered by a low glucose level of the host, then the messages can bestatements related to low glucose levels, such as “are you feelingokay?”, “should you drink some orange juice?”, and the like. Eachmessage can be user selectable, and when selected, cause the remotemonitor 114 to send the message to the host monitoring system fordisplay on the host monitoring system. In addition, selection of thenotification can automatically display a prompt to call the host, whereuser selection of the prompt causes the remote monitor to dial the phonenumber associated with the host (e.g. a smartphone that is part of thehost monitoring system).

Motivational Messages

In some example implementations, the alerts sent to the receiver 102and/or the notification messages may include motivational concepts. Forexample, if the host-patient has minimized the rate of change inglycemic levels, the secure server may send an alert to the receiver 102and/or a notification message to remote monitor 114 stating “Great jobmaintaining your therapy-keep it up!.” These motivational concepts maypositively motivate the users to stay on the therapy program. In someexample implementations, secure server 110 may include one or moreevents mapped to motivational concepts, so that triggering an eventcauses sending a message including the motivation concept to thereceiver 102 and/or a remote monitor 114.

In some example implementations, the secure server 110 may use patterns,as noted above, to predict aspects of the patient-host's treatment. Forexample, a pattern may detect a glycemic change at a given time of dayfrom a prior, established pattern, and then trigger a rule to send analert to the receiver 102 and a notification to the receiver 114stating, “Did you miss lunch?” These simple, non-technical querymessages may evoke a better response from the host-patient to maintain atherapy, when compared to only providing measured data or statistics toa host-patient or remote monitor. In some example implementations,secure server 110 may include one or more events mapped to simplemessages, so that triggering an event causes sending a message includingthe simple message to the receiver 102 and/or a remote monitor 114.

Audit Trail

The secure server 110 may also provide an audit trail. For example, thesecure server 110 may store information related to when notificationswere pushed to the remote monitor 114 using, for example, notificationservice 112, and when the remote monitor acknowledges the notification.The secure server 110 may also generate one or more reports to determinetimelines and/or identify the effectiveness of remote monitors 114(which can be used to select remote monitors and/or settings of system100, such as alert settings, to more effectively monitor host 199).

Timestamping

In some implementations, analyte levels provided to remote monitors 114may not be real-time. For example, while it may be desired to provideanalyte values to remote monitors in real time, there may be a timedelay between when the analyte value is measured by the analyte sensorsystem 8 and when the analyte level is provided to the remote monitor114 and/or secure server 110. The delay may be due to any of the sensorsystem 8 only transmitting values periodically to the receiver 102, thereceiver 102 transmitting only periodically values to gateway 104, thegateway having difficulty connecting to secure server 110, and secureserver having difficulty connecting to remote monitor 114, for example.Consequently, in some implementations, a glucose value transmitted tothe remote monitor 114 is displayed on the remote monitor with a timeindicating the time the analyte value that triggered the notificationcorresponds to (e.g., the analyte value that met or exceeded thethreshold that triggered the notification). The time may be the time ofday the analyte value was measured (e.g., 2:10 p.m. Pacific StandardTime), or may be a difference in time since the analyte value wasmeasured (e.g., 2 minutes ago, 30 minutes ago, 4 hours ago, etc.).

In addition, due to a time delay, the secure server 110 may end upsending a notification to remote monitor 114 based on a time delayedanalyte value. In such a case, the notification can include a timeassociated with the alert that triggered the notification, such as“Mike's blood glucose went below 70 mg/dl at 2:10 P.S.T.” or “Mike'sblood glucose went below 70 mg/dl 25 minutes ago.” Further, because anotification may not be viewed right away on the remote monitoringdevice, the remote monitoring device 114 can update any time associatedwith the notification until the notification is acknowledged.

To accommodate for differentness in time zones between a host and aremote monitor, the remote monitoring system can use a universal timeand then convert the universal time to the time zone of the remotemonitor, in accordance with some implementations. That is, a time stampof a sensor data value generated by host monitoring system 198 andprovided to secure server 110 can be in Universal Standard time (UST) orGreenwich Mean Time (GMT) and provided to the remote monitor 114 in thesame universal time, whereby the remote monitor converts the universaltime to the time zone in which the remote monitor is located.

In some implementations, due to difficulties with displaying time due totime lag and potential time zone differences between a host monitoringsystem 198 and remote monitor 114, which can cause confusion,notifications sent to remote monitor 114 do not display a time. Toremedy the lack of time indication, some implementations automaticallyopen the remote monitoring application on the remote monitor 114 anddisplay the user's monitored health information upon user acknowledgmentof the notification. The host's monitored health information that isinitially displayed upon opening the application can include indicationsof the host's current state, such as the most current analyte valueand/or a trend graph showing the past three hours of the host's measuredanalyte level.

Loss of Data Transmission

In some implementations, data may not be transmitted at times from thesensor system 8 to the secure server 110. This may be due to anunintentional lost data transmission connection between one or more ofsensor system 8 and receiver 102, receiver 102 and gateway 104, dockingstation 103 and host communication device 105, or gateway 104 and secureserver 110, for example. Or, the loss may be intentional, such as a userturning one or more of the components of the remote monitoring system100 off, such as the receiver 102 or host communication device 105. Inany such instance, the secure server 110 can be configured to send anotification indicating the loss of data transmission to one or more ofthe host monitoring system 198 and remote monitors 114A-114M.

However, it may be at times desirable not to send a notification soremote monitors 114 are not overly messaged. As an example, a host beingmonitored may be sleeping at night and get up to go to the kitchen for adrink of water. This can result in a loss of data transmission if thesensor system 8 is out of range from the receiver 102 resting on anightstand of the host 199, for example. Consequently, a delayassociated with loss of data transmission errors can be implemented sothat the server 110 initiates a loss of data notification only if datais not received after a predetermined amount of time or after apredetermined number of attempted connection attempts with hostmonitoring system 198.

Further, it may be desirable to not send loss of data notificationsevery time there is a loss of data transmission, even if the loss ofdata transmission is for an extended period of time. For example, in theimplementation of FIG. 2C, the docking station 103 may be stationary.Thus, a host may only be able to transmit health readings when the hosthas the receiver 102 docked in the docking station and the host is insufficient proximity to the receiver and docking station for datatransmission. However, a host may want to remove his or her receiver 102from the docking station 103 when the host leaves for work, for example.It may not be desirable to trigger a notification to remote monitors 114when the host removes the receiver from the docking station 103, as thismay not be considered an important enough event.

Accordingly, in some implementations, the remote monitoring system 100can determine that the receiver was removed from the docking station 103as opposed to, for some reason, the host monitoring system 198 is notfunctioning correctly and not providing sensor data to the secureserver. In one implementation, the remote monitoring system 100determines that the receiver is not docked in the docking station 103 bymonitoring transmissions from the cradle. For instance, transmissionsfrom the docking station 103 that include information generated by thereceiver 102 indicates that the receiver is docked and transmissionsfrom the docking station 103 that do not include information generatedby the receiver indicates that the receiver has been removed from thedocking station.

Eyewear Display Device

Although the above disclosure is primarily described with respect to useof a hand-held computing device, it should be understood that otherdevices can be used instead or in place of the smart phone. For example,in some implementations, sensor data are transmitted from the personalcomputing device to a computing device in the form of eyewear andmessages and information displayed on the eyewear for the user to view.An example of such eyewear is Google Glasses manufactured by Google,Inc. The user's eyewear interface can use a near-field radio link toreceive data, either directly from sensor system 8, or through anintermediary device, such as receiver 102 or gateway 104.

In some implementations, transmission of the data may be event-driven.For example, driven by the occurrence of a low or high glucoseexcursion, as discussed herein.

Various implementations of the subject matter described herein may berealized in digital electronic circuitry, integrated circuitry,specially designed ASICs (application specific integrated circuits),computer hardware, firmware, software, and/or combinations thereof. Thecircuitry may be affixed to a printed circuit board (PCB), or the like,and may take a variety of forms, as noted. These various implementationsmay include implementation in one or more computer programs that areexecutable and/or interpretable on a programmable system including atleast one programmable processor, which may be special or generalpurpose, coupled to receive data and instructions from, and to transmitdata and instructions to, a storage system, at least one input device,and at least one output device.

These computer programs (also known as programs, software, softwareapplications, or code) include machine instructions for a programmableprocessor, and may be implemented in a high-level procedural and/orobject-oriented programming language, and/or in assembly/machinelanguage. As used herein, the term “machine-readable medium” refers toany non-transitory computer program product, apparatus and/or device(e.g., magnetic discs, optical disks, memory, Programmable Logic Devices(PLDs)) used to provide machine instructions and/or data to aprogrammable processor, including a machine-readable medium thatreceives machine instructions.

To provide for interaction with a user, the subject matter describedherein may be implemented on a computer having a display device (e.g., aCRT (cathode ray tube) or LCD (liquid crystal display) monitor) fordisplaying information to the user and a keyboard and a pointing device(e.g., a mouse or a trackball) by which the user may provide input tothe computer. Other kinds of devices may be used to provide forinteraction with a user as well; for example, feedback provided to theuser may be any form of sensory feedback (e.g., visual feedback,auditory feedback, or tactile feedback); and input from the user may bereceived in any form, including acoustic, speech, or tactile input.

The subject matter described herein may be implemented in a computingsystem that includes a back-end component (e.g., as a data server), orthat includes a middleware component (e.g., an application server), orthat includes a front-end component (e.g., a client computer having agraphical user interface or a Web browser through which a user mayinteract with an implementation of the subject matter described herein),or any combination of such back-end, middleware, or front-endcomponents. The components of the system may be interconnected by anyform or medium of digital data communication (e.g., a communicationnetwork). Examples of communication networks include a local areanetwork (“LAN”), a wide area network (“WAN”), the public land mobilenetwork, satellite networks, and the Internet.

Although a few variations have been described in detail above, othermodifications are possible. For example, while the descriptions ofspecific implementations of the current subject matter discuss analyticapplications, the current subject matter is applicable to other types ofsoftware and data services access as well. Moreover, although the abovedescription refers to specific products, other products may be used aswell. In addition, the logic flows depicted in the accompanying figuresand described herein do not require the particular order shown, orsequential order, to achieve desirable results. Moreover, as used hereinthe term “set” includes zero or more items, and the phrase “based on”can be used interchangeably (unless otherwise noted) with the phrase“based on at least.” Other implementations may be within the scope ofthe following claims.

While the disclosure has been illustrated and described in detail in thedrawings and foregoing description, such illustration and descriptionare to be considered illustrative or exemplary and not restrictive. Thedisclosure is not limited to the disclosed embodiments. Variations tothe disclosed embodiments can be understood and effected by thoseskilled in the art in practicing the claimed disclosure, from a study ofthe drawings, the disclosure and the appended claims.

Methods and devices that are suitable for use in conjunction withaspects of the preferred embodiments are disclosed in U.S. Pat. Nos.4,757,022; 4,994,167; 6,001,067; 6,558,321; 6,702,857; 6,741,877;6,862,465; 6,931,327; 7,074,307; 7,081,195; 7,108,778; 7,110,803;7,134,999; 7,136,689; 7,192,450; 7,226,978; 7,276,029; 7,310,544;7,364,592; 7,366,556; 7,379,765; 7,424,318; 7,460,898; 7,467,003;7,471,972; 7,494,465; 7,497,827; 7,519,408; 7,583,990; 7,591,801;7,599,726; 7,613,491; 7,615,007; 7,632,228; 7,637,868; 7,640,048;7,651,596; 7,654,956; 7,657,297; 7,711,402; 7,713,574; 7,715,893;7,761,130; 7,771,352; 7,774,145; 7,775,975; 7,778,680; 7,783,333;7,792,562; 7,797,028; 7,826,981; 7,828,728; 7,831,287; 7,835,777;7,857,760; 7,860,545; 7,875,293; 7,881,763; 7,885,697; 7,896,809;7,899,511; 7,901,354; 7,905,833; 7,914,450; 7,917,186; 7,920,906;7,925,321; 7,927,274; 7,933,639; 7,935,057; 7,946,984; 7,949,381;7,955,261; 7,959,569; 7,970,448; 7,974,672; 7,976,492; 7,979,104;7,986,986; 7,998,071; 8,000,901; 8,005,524; 8,005,525; 8,010,174;8,027,708; 8,050,731; 8,052,601; 8,053,018; 8,060,173; 8,060,174;8,064,977; 8,073,519; 8,073,520; 8,118,877; 8,128,562; 8,133,178;8,150,488; 8,155,723; 8,160,669; 8,160,671; 8,167,801; 8,170,803;8,195,265; 8,206,297; 8,216,139; 8,229,534; 8,229,535; 8,229,536;8,231,531; 8,233,958; 8,233,959; 8,249,684; 8,251,906; 8,255,030;8,255,032; 8,255,033; 8,257,259; 8,260,393; 8,265,725; 8,275,437;8,275,438; 8,277,713; 8,280,475; 8,282,549; 8,282,550; 8,285,354;8,287,453; 8,290,559; U.S. Pat. Nos. 8,290,560; 8,290,561; 8,290,562;8,292,810; 8,298,142; 8,311,749; 8,313,434; 8,321,149; 8,332,008;8,346,338; 8,364,229; 8,369,919; 8,374,667; 8,386,004; and 8,394,021.

Methods and devices that are suitable for use in conjunction withaspects of the preferred embodiments are disclosed in U.S. PatentPublication No. 2003-0032874-A1; U.S. Patent Publication No.2005-0033132-A1; U.S. Patent Publication No. 2005-0051427-A1; U.S.Patent Publication No. 2005-0090607-A1; U.S. Patent Publication No.2005-0176136-A1; U.S. Patent Publication No. 2005-0245799-A1; U.S.Patent Publication No. 2006-0015020-A1; U.S. Patent Publication No.2006-0016700-A1; U.S. Patent Publication No. 2006-0020188-A1; U.S.Patent Publication No. 2006-0020190-A1; U.S. Patent Publication No.2006-0020191-A1; U.S. Patent Publication No. 2006-0020192-A1; U.S.Patent Publication No. 2006-0036140-A1; U.S. Patent Publication No.2006-0036143-A1; U.S. Patent Publication No. 2006-0040402-A1; U.S.Patent Publication No. 2006-0068208-A1; U.S. Patent Publication No.2006-0142651-A1; U.S. Patent Publication No. 2006-0155180-A1; U.S.Patent Publication No. 2006-0198864-A1; U.S. Patent Publication No.2006-0200020-A1; 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Methods and devices that are suitable for use in conjunction withaspects of the preferred embodiments are disclosed in U.S. applicationSer. No. 09/447,227 filed on Nov. 22, 1999 and entitled “DEVICE ANDMETHOD FOR DETERMINING ANALYTE LEVELS”; U.S. application Ser. No.12/828,967 filed on Jul. 1, 2010 and entitled “HOUSING FOR ANINTRAVASCULAR SENSOR”; U.S. application Ser. No. 13/461,625 filed on May1, 2012 and entitled “DUAL ELECTRODE SYSTEM FOR A CONTINUOUS ANALYTESENSOR”; U.S. application Ser. No. 13/594,602 filed on Aug. 24, 2012 andentitled “POLYMER MEMBRANES FOR CONTINUOUS ANALYTE SENSORS”; U.S.application Ser. No. 13/594,734 filed on Aug. 24, 2012 and entitled“POLYMER MEMBRANES FOR CONTINUOUS ANALYTE SENSORS”; U.S. applicationSer. No. 13/607,162 filed on Sep. 7, 2012 and entitled “SYSTEM ANDMETHODS FOR PROCESSING ANALYTE SENSOR DATA FOR SENSOR CALIBRATION”; U.S.application Ser. 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All references cited herein are incorporated herein by reference intheir entirety. To the extent publications and patents or patentapplications incorporated by reference contradict the disclosurecontained in the specification, the specification is intended tosupersede and/or take precedence over any such contradictory material.

Unless otherwise defined, all terms (including technical and scientificterms) are to be given their ordinary and customary meaning to a personof ordinary skill in the art, and are not to be limited to a special orcustomized meaning unless expressly so defined herein. It should benoted that the use of particular terminology when describing certainfeatures or aspects of the disclosure should not be taken to imply thatthe terminology is being re-defined herein to be restricted to includeany specific characteristics of the features or aspects of thedisclosure with which that terminology is associated. Terms and phrasesused in this application, and variations thereof, especially in theappended claims, unless otherwise expressly stated, should be construedas open ended as opposed to limiting. As examples of the foregoing, theterm ‘including’ should be read to mean ‘including, without limitation,’‘including but not limited to,’ or the like; the term ‘comprising’ asused herein is synonymous with ‘including,’ ‘containing,’ or‘characterized by,’ and is inclusive or open-ended and does not excludeadditional, unrecited elements or method steps; the term ‘having’ shouldbe interpreted as ‘having at least;’ the term ‘includes’ should beinterpreted as ‘includes but is not limited to;’ the term ‘example’ isused to provide exemplary instances of the item in discussion, not anexhaustive or limiting list thereof; adjectives such as ‘known’,‘normal’, ‘standard’, and terms of similar meaning should not beconstrued as limiting the item described to a given time period or to anitem available as of a given time, but instead should be read toencompass known, normal, or standard technologies that may be availableor known now or at any time in the future; and use of terms like‘preferably,’ ‘preferred,’ ‘desired,’ or ‘desirable,’ and words ofsimilar meaning should not be understood as implying that certainfeatures are critical, essential, or even important to the structure orfunction of the invention, but instead as merely intended to highlightalternative or additional features that may or may not be utilized in aparticular embodiment of the invention. Likewise, a group of itemslinked with the conjunction ‘and’ should not be read as requiring thateach and every one of those items be present in the grouping, but rathershould be read as ‘and/or’ unless expressly stated otherwise. Similarly,a group of items linked with the conjunction ‘or’ should not be read asrequiring mutual exclusivity among that group, but rather should be readas ‘and/or’ unless expressly stated otherwise.

Where a range of values is provided, it is understood that the upper andlower limit, and each intervening value between the upper and lowerlimit of the range is encompassed within the embodiments.

With respect to the use of substantially any plural and/or singularterms herein, those having skill in the art can translate from theplural to the singular and/or from the singular to the plural as isappropriate to the context and/or application. The varioussingular/plural permutations may be expressly set forth herein for sakeof clarity. The indefinite article “a” or “an” does not exclude aplurality. A single processor or other unit may fulfill the functions ofseveral items recited in the claims. The mere fact that certain measuresare recited in mutually different dependent claims does not indicatethat a combination of these measures cannot be used to advantage. Anyreference signs in the claims should not be construed as limiting thescope.

It will be further understood by those within the art that if a specificnumber of an introduced claim recitation is intended, such an intentwill be explicitly recited in the claim, and in the absence of suchrecitation no such intent is present. For example, as an aid tounderstanding, the following appended claims may contain usage of theintroductory phrases “at least one” and “one or more” to introduce claimrecitations. However, the use of such phrases should not be construed toimply that the introduction of a claim recitation by the indefinitearticles “a” or “an” limits any particular claim containing suchintroduced claim recitation to embodiments containing only one suchrecitation, even when the same claim includes the introductory phrases“one or more” or “at least one” and indefinite articles such as “a” or“an” (e.g., “a” and/or “an” should typically be interpreted to mean “atleast one” or “one or more”); the same holds true for the use ofdefinite articles used to introduce claim recitations. In addition, evenif a specific number of an introduced claim recitation is explicitlyrecited, those skilled in the art will recognize that such recitationshould typically be interpreted to mean at least the recited number(e.g., the bare recitation of “two recitations,” without othermodifiers, typically means at least two recitations, or two or morerecitations). Furthermore, in those instances where a conventionanalogous to “at least one of A, B, and C, etc.” is used, in generalsuch a construction is intended in the sense one having skill in the artwould understand the convention (e.g., “a system having at least one ofA, B, and C” would include but not be limited to systems that have Aalone, B alone, C alone, A and B together, A and C together, B and Ctogether, and/or A, B, and C together, etc.). In those instances where aconvention analogous to “at least one of A, B, or C, etc.” is used, ingeneral such a construction is intended in the sense one having skill inthe art would understand the convention (e.g., “a system having at leastone of A, B, or C” would include but not be limited to systems that haveA alone, B alone, C alone, A and B together, A and C together, B and Ctogether, and/or A, B, and C together, etc.). It will be furtherunderstood by those within the art that virtually any disjunctive wordand/or phrase presenting two or more alternative terms, whether in thedescription, claims, or drawings, should be understood to contemplatethe possibilities of including one of the terms, either of the terms, orboth terms. For example, the phrase “A or B” will be understood toinclude the possibilities of “A” or “B” or “A and B.”

All numbers expressing quantities of ingredients, reaction conditions,and so forth used in the specification are to be understood as beingmodified in all instances by the term ‘about.’ Accordingly, unlessindicated to the contrary, the numerical parameters set forth herein areapproximations that may vary depending upon the desired propertiessought to be obtained. At the very least, and not as an attempt to limitthe application of the doctrine of equivalents to the scope of anyclaims in any application claiming priority to the present application,each numerical parameter should be construed in light of the number ofsignificant digits and ordinary rounding approaches.

Furthermore, although the foregoing has been described in some detail byway of illustrations and examples for purposes of clarity andunderstanding, it is apparent to those skilled in the art that certainchanges and modifications may be practiced. Therefore, the descriptionand examples should not be construed as limiting the scope of theinvention to the specific embodiments and examples described herein, butrather to also cover all modification and alternatives coming with thetrue scope and spirit of the invention.

What is claimed is:
 1. A method comprising: identifying, by a remotemonitor, a set of one or more rules that define conditions forcommunications between a secure server and the remote monitor, whereinthe set of one or more rules are provided to the remote monitor by thesecure server and associated with data associated with a receiverconfigured to monitor an analyte state of a host, wherein the set of oneor more rules are generated according to one or more preferences orsettings from a host device, and wherein the host device sets a firstsetting of the one or more preferences or settings; and modifying, bythe remote monitor, at least one rule of the set of one or more ruleswherein the set of one or more rules include a first rule defining analert representative of an event associated with the analyte state ofthe host, the event being determined by the secure server based on afirst measurement of the data associated with the receiver regarding theanalyte state of the host at a first time, wherein the alert, whentriggered at the first time, causes an alert message to be sent to theremote monitor from the secure server to notify the remote monitor ofthe event, wherein modifying the at least one rule of the set of one ormore rules comprises modifying, by the remote monitor, the first settingset by the host device, and wherein modifying the first setting by theremote monitor modifies the first setting for the remote monitor withoutchanging the first setting at the host device.
 2. The method of claim 1,wherein the at least one rule is the first rule, wherein modifying thefirst rule comprises varying a first threshold associated with a lowlevel of glucose at the host, and wherein the event being determined bythe secure server is further based on the first measurement indicatingan analyte measurement that is lower than the first threshold.
 3. Themethod of claim 1, wherein the at least one rule is the first rule,wherein modifying the first rule comprises varying a second thresholdassociated with a high level of glucose at the host, and wherein theevent being determined by the secure server is further based on thefirst measurement indicating an analyte measurement that is higher thanthe second threshold.
 4. The method of claim 1, wherein the set of oneor more rules further comprise a second rule that defines a delaybetween when a notification message is sent to the receiver and when thealert message is sent to the remote monitor, the method furthercomprising modifying the second rule by varying the delay.
 5. The methodof claim 1, further comprising: receiving, at the remote monitor, aninvitation to access the secure server and the data associated with thereceiver; and providing, from the remote monitor to the secure server,an acceptance to the invitation.
 6. The method of claim 5, wherein theinvitation is associated with a set of recommended rule settingsconfigured by the host device, and wherein the recommended rule settingsare provided to the remote monitor for acceptance or modification. 7.The method of claim 5, wherein accepting the invitation,programmatically establishes an account associated with the remotemonitor at the secure server.
 8. The method of claim 1, wherein the setof one or more rules comprise a second rule defining a time value as towhen a reminder message is sent to the remote monitor after the alertmessage is sent to the remote monitor, the reminder message only beingsent if the alert message has not been previously acknowledged by theremote monitor and only if the event associated with the analyte stateof the host has not changed, based on a second measurement of the dataat a second time, after the alert message was sent.
 9. The method ofclaim 8, wherein the at least one rule is the second rule.
 10. Themethod of claim 8, wherein the time value is determined based on a typeor severity of the event triggering the alert.
 11. The method of claim8, wherein the reminder message is only sent if the alert has not beenpreviously acknowledged by the remote monitor and only if the eventassociated with the analyte state of the host further worsens.
 12. Anapparatus for remote monitoring of a host's analyte levels, theapparatus comprising: at least one processor; and at least one memoryincluding code, which when executed by the at least one processor causesthe apparatus to: identify, by the apparatus, a set of one or more rulesthat define conditions for communications between a secure server andthe apparatus, wherein the set of one or more rules are provided to theapparatus by the secure server and associated with data associated witha receiver configured to monitor an analyte state of a host, wherein theset of one or more rules are generated according to one or morepreferences or settings from a host device, and wherein the host devicesets a first setting of the one or more preferences or settings; andmodify at least one rule of the set of one or more rules, wherein theset of one or more rules include a first rule defining an alertrepresentative of an event associated with the analyte state of thehost, the event being determined by the secure server based on a firstmeasurement of the data associated with the receiver regarding theanalyte state of the host at a first time, wherein the alert, whentriggered at the first time, causes an alert message to be sent to theapparatus from the secure server to notify the apparatus of the event,wherein modifying the at least one rule of the set of one or more rulescomprises modifying, by the apparatus, the first setting set by the hostdevice, and wherein modifying the first setting by the apparatusmodifies the first setting for the apparatus without changing the firstsetting at the host device.
 13. The apparatus of claim 12, wherein theat least one rule is the first rule, wherein modifying the first rulecomprises varying a first threshold associated with a low level ofglucose at the host, and wherein the event being determined by thesecure server is further based on the first measurement indicating ananalyte measurement that is lower than the first threshold.
 14. Theapparatus of claim 12, wherein the at least one rule is the first rule,wherein modifying the first rule comprises varying a second thresholdassociated with a high level of glucose at the host, and wherein theevent being determined by the secure server is further based on thefirst measurement indicating an analyte measurement that is higher thanthe second threshold.
 15. The apparatus of claim 12, wherein the set ofone or more rules further comprise a second rule that defines a delaybetween when a notification message is sent to the receiver and when thealert message is sent to the apparatus, and wherein the code furthercauses the apparatus to modify the second rule by varying the delay. 16.The apparatus of claim 12, wherein the at least one rule is a secondrule defining a time value as to when a reminder message is sent to theapparatus after the alert message is sent to the apparatus, the remindermessage only being sent if the alert message has not been previouslyacknowledged by the apparatus and only if the event associated with theanalyte state of the host has not changed, based on a second measurementof the data at a second time, after the alert message was sent.
 17. Theapparatus of claim 12, wherein the code, when executed by the at leastone processor further causes the apparatus to: receive an invitation toaccess the secure server and the data associated with the receiver; andprovide an acceptance to the invitation.
 18. The apparatus of claim 17,wherein the invitation is associated with a set of recommended rulesettings configured by the host device, and wherein the recommended rulesettings are provided to the apparatus for acceptance or modification.19. The apparatus of claim 17, wherein the apparatus is configured toaccept the invitation responsive to user input at the apparatus, andwherein accepting the invitation, programmatically establishes anaccount associated with the apparatus at the secure server.